Collaboration Brings Virtual ICUs to Huntley and McHenry
July 28, 2020 | 4 min. to read
Huntley Hospital and McHenry Hospital now have virtual ICU capabilities thanks to a cross-regional collaboration that began during the initial COVID-19 response.
The two hospitals rely on Northwestern Memorial Hospital as a backup to transfer patients if their ICUs are overloaded or for cases that are particularly complex. But in early spring, NMH had little ability to accept transfers due a rapid increase in its census of patients with COVID-19.
Huntley and McHenry also were seeing patients with COVID-19 and planning for a possible surge. Huntley Anesthesia Associates, which works with the two hospitals, quickly stepped in to support their ICUs by providing overnight intensivist coverage on-site during the spring. Still, physicians worried that the hospitals could quickly find their ICU resources strained by a cluster of cases or staff illnesses.
With these thoughts in mind, physician leaders collaborated across the Central and Northwest regions on a multi-tiered approach to ensure that Huntley and McHenry would have additional ICU support if needed:
First, NMH pulmonary critical care specialists volunteered to be available by page for telephone consults for complex patients, and a function to page them was added to Epic.
Second, the project team reached out to Richard Bernstein, MD, medical director of the Northwestern Medicine Telehealth Program, to see if technology could provide a more advanced solution.
Dr. Bernstein recommended placing telemonitoring cameras in patient rooms on COVID-19 units and suggested the Whiteboard Virtual ICU Telemonitoring System. NM physicians have had positive experiences with Whiteboard through other telehealth projects, leading NM to become a financial investor in the company.
The ceiling-mounted cameras livestream video to a monitoring site. The care team may remotely pan, tilt or zoom the camera to see the patient and any medical equipment in the room. The cameras enable physicians to check on patients from outside the room, which might be preferred during epidemics, or from off-site, which would be the case if NMH physicians are called on to consult.
“While we can get a lot of perspective from the shared medical record, the visual feed from a camera adds valuable information,” says Benjamin D. Singer, MD, a pulmonary and critical care medicine physician at NMH who was one of the leaders of the project and an assistant professor of Medicine at Feinberg School of Medicine. “For example, we can zoom in on the ventilator interface to direct adjustments in real time and watch how the patient responds. Those adjustments are a large part of ventilator management and a critical skill in COVID-19 care.”
The Illinois stay-at-home order helped to flatten the spring outbreak, and the anesthesiologists provided extra intensivist support. As a result, project leaders did not need to activate the pager system or accelerate the virtual ICU project. However, due to the planning begun in spring, Whiteboard Telemonitoring cameras now have been installed in 51 ICU rooms at Huntley and McHenry, meaning virtual ICU capabilities are available for any crisis that may come, as well as for a myriad of other uses.
“COVID-19 was an opportunity to rethink our ability to manage ICU patients,” says Irfan Hafiz, MD, vice president and chief medical officer of the Northwest Region, who helped with the project. “For COVID-19 or any crisis, this will allow us to leverage a variety of system resources, especially now that we are on Epic like the rest of NM.”
Other possible uses for the technology include monitoring patients who are at risk of falling, and facilitating urgent consults at one hospital by physicians who are still on rounds at the other. “We are thinking about all the ways we can use this technology within the hospital, within the region and across the system,” Dr. Hafiz says.
Several people played important roles in advancing the cross-regional collaboration. In addition to Dr. Hafiz and Dr. Singer, those include:
Jens P. Kellermeier, MD, medical director of Surgical Services in the Northwest Region and an anesthesiology and critical care medicine physician
Daniel J. Nepomuceno, MD, a pulmonary, critical care and sleep medicine physician at Huntley and McHenry
Richard G. Wunderink, MD, medical director of the MICU at NMH and a professor of Medicine at Feinberg
Chip Rank, program director of Thoracic Surgery and Pulmonary for Northwestern Medical Group
Kali Arduini and her team in NM Project Management
The Northwest Region virtual ICUs are just one example of NM’s extensive telehealth investments. Including that project, NM has installed more than 700 cameras across its hospitals to allow for remote monitoring of patients. “Having the cameras in place protects caregivers during the pandemic by allowing them to evaluate patients without putting themselves at risk when they don’t have to,” Dr. Bernstein says. “It also is a way to optimize physician capacity, by using excess capacity in one region to fill in gaps in another. Telehealth has its place just like inpatient, outpatient and immediate care.”
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