eCare Program for Rural Hospitals

New eCare Program to Reach Rural Maryland Hospitals with Tele-ICU

Through telemedicine and tele-ICU services, the University of Maryland’s eCare program offers remote patient monitoring — expanding the possibilities for lifesaving care. When an elderly woman began developing confounding symptoms late one night in a rural Maryland hospital, it was someone many miles away who first noticed she was having a heart attack. Sitting in Baltimore surrounded by technology, an intensivist from the University of Maryland Medical Center was able to zero in on the diagnosis using sophisticated equipment that remotely monitored subtle trends in the patient’s vital signs. The physician then quickly worked together with staff from the smaller hospital to address the woman’s worsening condition.

This recent scenario is just one of the benefits of the new UMMS eCare system, which launched on April 30 and serves six rural Maryland hospitals. Also known as the tele-ICU, the telemedicine technology allows intensivists and critical care RNs from a central operations room (or COR) at the University of Maryland to oversee patient care in ICUs and emergency departments during night and weekend hours, providing a virtual safety net for these smaller facilities.

The system uses cutting-edge cameras in patient rooms along with information such as patients’ vital signs and laboratory and pharmaceutical data, picking up even slight changes in their physical condition during off-peak hours when onsite staffing is reduced. An “eLert” button in each patient room also allows ICU staff to request eCare assistance.

“This trend is exploding across the country,” says Marc T. Zubrow, M.D., vice president of telemedicine and medical director of eCare. “We’re the 54th site to go up with a tele-ICU, and greater than 12% of ICU beds across the country are under such a program, so it really is coming on strong.”

The eCare initiative here is the brainchild of Glenn Robbins, M.D., senior vice president and UMMS chief medical officer, who retired June 30. Dr. Robbins began investigating the logistics of such a program years ago and was “clearly a visionary motivator,” says Dr. Zubrow, an associate professor of medicine. All six rural hospitals under the UMMS eCare umbrella represent a microcosm of the United States, where the concentration of intensivists in small towns is low, he says, and training critical care nurses — which tend to have a high turnover rate — is expensive and challenging.

Telemedicine Technology

Included in the new eCare program are Atlantic General Hospital in Berlin; Calvert Memorial Hospital in Prince Frederick; Peninsula Regional Medical Center in Salisbury; MedStar St. Mary’s Hospital in Leonardtown; Meritus Medical System in Hagerstown; and Union Hospital in Elkton. Each local hospital adheres to certain minimum requirements, including having a physician in-house for procedural emergencies during tele-ICU hours, Dr. Zubrow says. On the UMMS side, one eCare physician is available for every 100 to 120 patients along with one eCare RN for every 30 patients.

“One of the keys to making this work is the IT integration,” Dr. Zubrow explains. “When I’m sitting in the COR, I see all the patients’ X-rays, I see all their vital signs, their rhythm strips, every bit of information I would have if I were in that hospital, but sitting in a remote center.

“The computer will sense patient trends faster than I will as a clinician. If there’s a 10% increase in heart rate, it will send an electrical signal saying, look at this patient,” he adds. “It may be nothing, but it gets a set of human eyes looking at that patient’s overall picture. The perception out there is that we’re hitting home runs all night, saving lives left and right, but most of the time we’re fixing little things so they don’t become big things.”

The Local Impact

At Atlantic General Hospital in Berlin — about 140 miles from the University of Maryland — being part of the tele-ICU helps keep on-call intensivists “fresher” for work during daytime hours, providing improved care for patients by appropriately managing their vital signs, according to Atif Zeeshan, M.D., director of the ICU and sleep lab there.

“Some statistics say that tele-ICU programs help with morbidity and mortality,” Dr. Zeeshan says. “I think most hospitals are realizing that, with the complexity of patients, you do need an intensivist’s presence during the night as well. This is the best alternative you can have.”

Before Atlantic General became part of eCare, Dr. Zeeshan would often be buzzed every 15 or 30 minutes when he was on-call during the night. “It was very hard to function the next day,” he says, noting his 24-hour shifts. “eCare makes my day much easier. It helps us manage all the things that are major in nature and can be done remotely. So it’s a big safety net.”

Dr. Zubrow says local communities and their residents appreciate having access to the tele-ICU. “They want to have the confidence that their local hospital can take care of them locally,” he adds. “We have found that families absolutely love it.”

Positioned for the future

UMMS hopes to someday leverage the eCare technology for other applications in addition to the tele-ICU, Dr. Zubrow says. First up will be providing tele-ICU services to hospitals along Maryland’s eastern shore, which includes rural, underserved areas. After that, Zubrow envisions potentially using the technology to provide other services, including those in psychiatry, stroke, dermatology, wound care, pediatrics, trauma, ob/gyn, long-term acute care and subacute care.

 “One hospital may not have neurology, and we can provide them with tele-stroke services,” Dr. Zubrow says. “Or with a dermatologist, for example. I think this out-of-the-box thinking positions the University of Maryland to take that next step in providing more complete supportive care to the local community without it being necessary for people to drive to Baltimore to get these specialty health services.”

To refer a patient for consultation, please call 1-800-373-4111. For an urgent transfer, please call University of Maryland ExpressCare at 410-328-1234.