With eICU, physicians in Australia monitor patients in Atlanta

There is concern that care in some hospitals may lag years behind. For the night shift at some Emory Healthcare hospitals, it literally runs 12 hours ahead thanks to the electronic ICU (eICU).

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Emory has a team of intensivist physicians and nurses based in Australia’s Royal Perth Hospital who start a 7 a.m. shift as their colleagues in Atlanta are clocking in at 7 p.m.

The eICU staff in Australia can communicate with physicians, other caregivers, patients and patient family members via high-definition televisions. The Perth team has access to the electronic health records of the ICU patients in Georgia, including x-rays and other imaging, and all the data from bedside physiologic monitors.

The AMA’s Digital Health Implementation Playbook packages the key steps, best practices and resources to accelerate the adoption of these and other digital health innovations and helps physicians extend care beyond the exam room.

Intensive innovation rewarded

Emory launched its eICU network in 2014 after receiving a $10.7 million Health Care Innovation Award from the Centers for Medicare & Medicaid Services (CMS). From its base at Emory Saint Joseph’s Hospital, the eICU team monitors critical care units at five other hospitals. An independent study by Abt Associates for CMS found the system to be working well.

Abt reported that Emory’s eICU network provided care for 8,019 patients between April 1, 2014 and June 30, 2015. The eICU was credited with lowering Medicare spending per patient episode by $1,486 relative to a comparison group of similar hospitals, leading to savings of $4.6 million during the period studied.

The eICU was associated with a 2.1 percentage point drop in 60-day inpatient readmissions, a 6.9 percentage point drop in discharges to skilled nursing facilities and long-term care hospitals and a corresponding 4.9 percentage point increase in discharges to home health care.

“Rapid attention to patient needs was the most important improvement credited to the eICU by physicians who worked there and by bedside ICU physicians and nurses,” Abt researchers said.

But they also predicted trouble ahead as the eICU physicians began to experience burnout as they rotated day, night and weekend shifts.

Then, it dawned on them

Then Emory Critical Care Center Director Timothy Buchman, MD, PhD, and Cheryl Hiddleson, director of the Emory eICU Center, came up with the idea of “turning night into day” by having staff in Australia.

The concept was tested at Macquarie University’s MQ Health in Sydney for six months in 2016, and it included tracking staff sleep cycles, mood changes, cortisol levels and overall quality of life.

A full analysis of the data is still being worked on. But the anecdotal evidence of the project’s success is overwhelming. “Everyone who has gone over has asked, ‘When can I do it again?’” Dr. Buchman said.

The program rebooted this spring and was moved some 2,000 miles west to Perth to better sync time zones. Staff will work on eight- to 16-week rotations for the next two to three years.

Dr. Buchman said the length of the current iteration of the project has been “reasonably pegged for three years,” and he compared the Emory-Australia eICU project to the early U.S. space program.

Dr. Buchman and his colleagues are trying to create a sustainable business model while perfecting technical skills like “making data flow from one side of the earth to another.”

“Our foray into Australia has opened many areas of opportunity to the telemedicine experience,” Dr. Buchman said, adding that—despite the distance—patients and their families have been able to forge relationships with clinicians in Perth. “We’re embraced as part of their care team and patients find value in the service we deliver.”

Hiddleson said that the Australian initiative is part of Emory’s mission “to provide more joy” for clinical staff and should serve as an effective recruitment tool.

“It puts us in the position of having a unique work experience,” she said.