Recovering from pneumonia is an unusual experience in the 10-bed intensive care unit at the Carolinas HealthCare System hospital in rural Lincolnton, North Carolina. The has its regular staff in Lincolnton, but Richard Gilbert, one of the ICU patients, has an extra nurse who is 45 miles away.
That registered nurse, Cassie Gregor, sits in front of six computer screens in an office building. She wears a headset, and her voice is piped into Gilbert鈥檚 room via computer speakers.
A doorbell sounds before the camera turns on, alerting Gilbert that the nurse is looking in. They chit-chat as Gregor monitors Gilbert鈥檚 vital signs. The nurse asks how he鈥檚 feeling and if there鈥檚 anything he needs.
听monitors ICUs in 10 of its hospitals from this command center near Charlotte. The command center is staffed 24-7 with a rotating crew of seven to nine nurses and doctors who specialize in critical care. Everyone on the team also does bedside shifts.
One of the screen鈥檚 in Richard Gilbert鈥檚 hospital room is a TV. The other is an eICU screen, that lets him see and converse with an extra nurse who checks on his care.
(Photo by Michael Tomsic/WFAE)
Carolinas HealthCare started this project about two years ago and says it鈥檚 good for staff and patients.
For one thing, medical staff at the command center can maintain a constant focus on patients. The command center is quiet 鈥� none of the alarms are going off that most ICUs need to alert nurses and doctors down the hall that they鈥檙e needed. 听says it鈥檚 a nice change of pace.
The peace, he says, 鈥渕akes it a much more pleasant environment actually to work in than what we鈥檙e used to 鈥� the usual chaos of the ICU.鈥�
Nurse Kimberly Purtill agrees.
鈥淲e might see a trend up with their white blood cells,鈥� Purtill says, or 鈥渁 trend up with their temperature, and their blood pressure going down.鈥� All those symptoms might be warning signs of an infection.
鈥淚f you were off yesterday as a bedside nurse, and you鈥檙e on today, you don鈥檛 have the picture from yesterday,鈥� she continues.
But the command center staff has easy access to medical histories and other data on the computer screen, she says, so it鈥檚 easy to give the bedside staff a heads up.
Lindblom oversees critical care for Carolinas HealthCare System and says there are clear signs the virtual ICU is working.
鈥淲e鈥檙e taking care of more patients than we were two years ago,鈥� he says, 鈥渁nd across the system, our mortality rate is dropping 鈥� and our length of stay is dropping. It鈥檚 almost the perfect storm of good care.鈥�
Among the 10 hospitals in the program, ICU mortality is down 5 percent and length of stay is down 6 percent. Lindblom says virtual care doesn鈥檛 get all the credit. He notes the hospitals have also rolled out a program to better manage sepsis, which is a leading cause of death. But Lindblom says that virtual care helps with that program and nearly everything else in the ICU.
Leah Binder is president of听, a national advocate for better hospital care. She said the gold standard is to have critical care doctors on-site, not on-camera.
鈥淗owever, that鈥檚 not always possible for every hospital and particularly in rural areas,鈥� Binder says, 鈥渟o second to that is a virtual environment.鈥�
As technology leads to better care, she says, it could also lead to lower costs.
In the Midwest, Avera Health estimates its virtual ICU has resulted in $70 million worth of savings over the past 10 years.听, who oversees the project for Avera, says that from one hub in South Dakota, Avera monitors patients as far away as Minnesota and Wyoming.
鈥淚 think we quit calculating miles a while back,鈥� she says, and laughs. 鈥淚t鈥檚 a very vast area of land.鈥�
From the left, registered nurses Cassie Gregor, Camellia Douglas and Mike Montalto monitor patients in intensive care units scattered around North Carolina.
(Photo by Kevin McCarthy/Carolinas HealthCare System)
Before virtual care, Larson says, complicated cases were often transferred to major medical centers. Now some of those patients can stay closer to home, and that鈥檚 good for them, their families, and the town鈥檚 economy.
鈥淜eeping 10 or 12 patients more 鈥� means another nursing job that stays local,鈥� Larson says, 鈥渕aybe another lab tech job. What the technology is really doing is keeping those economics closer to home and helping them maintain viability.鈥�
In other words, it may help the hospital in a small community stay open.
In Lincolnton, a town of about 11,000, Dr. Jessica Fox said her ICU has been much busier.
鈥淭he unit went from basically having a couple patients, and closing all the time because we were having to transfer so many patients, 鈥渢o now being almost full all the time because we鈥檙e able to keep patients here, 鈥� Fox says.
From his ICU bed, lifelong farmer Richard Gilbert says the more people looking after him, the better.
鈥淭hat鈥檚 sort of like me and farming,鈥� Gilbert says. 鈥淚f I鈥檝e got a five-man job, and I go out there with two people, [I] might miss something.鈥� But if you have your whole crew working, he says, 鈥測ou don鈥檛 miss anything. You get it done.鈥�
This story is part of NPR鈥檚 reporting partnership with WFAE and听.