VISN 10 Tele- ICU
CINCINNATI VAMC TELE-ICU PROGRAM MISSION To care for critically ill Veterans by providing attentive electronic ICU monitoring and consistent uninterrupted management utilizing state of the art critical care protocols and interventions in conjunction with their bedside clinical team. VISION To be a patient-centered, multidisciplinary team who combines technology and state of the art critical care with a compassionate and caring approach working seamlessly with the Veteran s direct care clinical staff to provide the highest quality critical care, research, and education. SLOGAN You watched after us, now it s our turn to watch over you.
Tele-ICU Milestones FY 2013 and Beyond Tele-ICU Expansion April 13, 2012 Cleveland MICU Go Live March 2013 Cleveland SICU + Satellite Resource Center Go Live September 6,2012 VHA Telehealth Services Certification December 20, 2012 National Tele-ICU Workgroup Recharter and Expansion Plans Unveiled January 10, 2012 Grand Opening Chillicothe, Cincinnati, Dayton
VISN 7 VISN 10
Cincinnati VAMC Tele-ICU Model Dayton ICU Satellite CRC Cleveland MICU/CCU SICU Central Resource Center (CRC) (Monitoring Center) Satellite CRC Collaborative/Integrative Interaction Staffing Model Nurses 24/7 Intensivist 4p-7a M-F 24/2 Sa-Su Cincinnati MICU/CCU SICU Chillicothe SCU New Site(s)
ecaremanager TM CPRS Technical Integra?on Vital signs/monitor VISTA ADT Labs Medica?ons- in tes?ng CIS PICIS/CliniComp Bedside char?ng Ven?lators Smart pumps CPRS
Personnel Integration Line is in, I ll call for a chest xray. His urine output has dropped off; Should he get another dose of lasix? Workflow Communication Trust Teamwork Education Would you watch this patient, while I. Second verifier for blood products Is there abdominal free air? Does this patient have autopeep?
What does TeleICU do? Textbook Answer A combination of communication technology, telemetry, electronic medical record, clinical information system (CIS), and/or digital imaging to allow remotely located critical care nurses and/or intensivists to participate in the management of critically ill patients Practical Answer Different things to each unit and its functions vary according to the patient and the situation In baseball parlance TeleICU is the utility critical care team player who can do just about everything except touch the patient and who helps the entire team play better
What can a TeleICU Nurse do? Reviews every new admission: history, exam, labs, orders Insures gi/dvt prophylaxis measures Meets and introduces TeleICU to every patient Rounds-audiovisual connection or chart review Monitors rhythm, vital signs, labs central line insertions glucose monitoring Interacts with patients, patients families, nurses, physicians, pharmacists, residents, students, respiratory therapists Assists bedside nurses with blood products, verifier for meds, patient monitoring, phone calls, contacting physicians/residents Responds to alerts-laboratory or physiologic Other ways to integrate with the bedside critical care team
What can a TeleICU Physician do? Reviews every new admission: history, exam, labs, orders Rounds-audiovisual connection or chart review Monitors rhythm, vital signs, labs Interacts with patients, patients families, nurses, physicians, pharmacists, residents, students, respiratory therapists Responds to alerts-physiologic or laboratory Reviews radiographic imaging, cardiac rhythms Assists bedside team with management questions/education Rounds with evening / night resident teams Available for discussions with family and patients Responds to alerts-laboratory, physiologic, medication Coordinate patient transfers from one facility to another Other ways to integrate with the bedside critical care team
Tele- ICU Metrics The Tele- ICU Clinical RN Staff interac7ons with bed- side clinical staff from January 2012 December 2012: o Chillicothe 616 interac7ons o Cincinna7 MICU 1208 interac7ons o Cincinna7 SICU 718 interac7ons o Cleveland MICU 663 interac7ons o Dayton 756 interac7ons MD interac7ons with bed- side clinical staff from January 2012 December 2012: o Chillicothe 75 interac7ons o Cincinna7 MICU 514 interac7ons o Cincinna7 SICU 431 interac7ons o Cleveland MICU 11 interac7ons o Dayton 230 interac7ons
Chillicothe IPEC Data Q4 FY13 Standardized Mortality Rate OMELOS Acute Severity Index
Dayton IPEC Data Q4 FY13 Standardized Mortality Rate OMELOS Acute Severity Index
Tele- ICU Current Clinical Ini7a7ves Central line inser7on program o Review of inser7on techniques with simula7on o Monitoring of line inser7ons Glucose control o Goal: reduce days with glucose >180 and episodes of hypoglycemia, <60 o Increase use of exis7ng protocols o Eventual standardiza7on of insulin regimens Resident Educa7on o Dayton and Cincinna7 Evening rounds Review of new admissions
Tele- ICU Future Clinical Ini7a7ves Skin care Mentoring new ICU nurses Ven7lator- associa7on pneumonia Post- resuscita7on cooling Sepsis: earlier detec7on and accelerated ini7al management