By Debra Wood, RN, contributor
June 4, 2012 - Disasters and mass-casualty events happen, and some hospitals and health systems are including telemedicine in their preparation. A few facilities have already deployed telemedicine solutions during disasters with good results.
Theresa M. Davis, RN, PhDc, discussed how the Northern Virginia Hospital Alliance has developed and tested through drills, using telemedicine to aid in the triage and treatment of patients after a disaster.
The benefits include increased situational awareness and the ability to treat patients in place while reducing triage and door-to-treatment times and mortality, said Theresa M. Davis, RN, PhDc, clinical operations director of enVision eICU at Inova Health System in Falls Church, Va., at the 2012 American Association of Critical-Care Nurses National Teaching Institute and Critical Care Exposition (NTI) in Orlando, Fla.
“Our teleICU has partnered with the disaster center in order to bring our expertise to multiple emergency departments through the Northern Virginia Hospital Alliance (NVHA), created after 9-11,” Davis said.
The alliance includes 14 hospitals and six freestanding emergency departments. The Northern Virginia alliance includes a primary incident command center and two alternate sites if that facility is not able to function. A $3.5 million federal grant allowed the alliance to put mobile telemedicine units in every hospital, aiming to provide secondary consultations, decision support, and triage of critically ill or injured patients in a mass casualty, Davis said.
NVHA has conducted three drills and worked through challenges, such as resistance to the technology, bandwidth and legal considerations, including physician credentials and malpractice issues. Throughout this time, Davis said, they have learned to “expect the unexpected,” while maintaining that preparation is essential to saving lives.
Intensivist H. Neal Reynolds, M.D., cared for patients from his home during a disaster.
In the journal Telemedicine and e-Health, H. Neal Reynolds, M.D., associate professor of medicine at the University of Maryland School of Medicine and chairman of critical care medicine at Bon Secours Hospital in Baltimore, and colleagues reported on his facility’s success in using telemedicine to manage patients during three blizzards that rendered the streets impassable.
Bon Secours Hospital had received the InTouch Health robot in 2004, with funding from a Health Resources and Services Administration grant, to improve the facility’s emergency response. Robot control stations, with connectivity to the hospitals’ radiographics and clinical information systems, were placed in intensivists’ homes. The hospital routinely uses the robot for evening intensivist rounds, keeping staff familiar with the technology.
When blizzards hit in 2009 and 2010, dumping nearly three feet of snow on the ground, the intensivists worked from home, assessing and treating patients with assistance from the robot. The physicians discussed the cases with bedside nurses and adjusted ventilator settings, vasoactive medication, volume expanders and plans of care. Physicians documented in the medical record. Reynolds reported that there were no complications associated with the remote visits.
Mercy health system in Missouri also reported good results when it put its eICU from Philips Healthcare into action after the deadly Lone Grove, Okla., tornado touched down in 2009 and produced an influx of patients at its nearby Mercy Memorial Health Center in Ardmore. TeleICU clinicians were able to monitor patients in that facility’s ICU, freeing up most of the staff to care for incoming emergency patients. One nurse cared for patients in the 10-bed ICU while the telemedicine staff monitored and documented the care.
Wendy Deibert, RN, BSN, described the post-tornado response at St. John’s Regional Medical Center in Joplin, Mo., at the AACN NTI.
“It was a work-together environment, and everyone was safe,” said Wendy Deibert, RN, BSN, executive director of telemedicine services at Mercy, who also spoke at the NTI.
The Mercy teleICU staff also helped alert clinicians at receiving hospitals when the Ardmore hospital began transferring patients to a higher level of care.
Unfortunately, the team could not do the same when a tornado destroyed Mercy’s St. John’s Regional Medical Center in Joplin, Mo., in May 2011. Staff at the 367-bed hospital evacuated patients, began triaging new arrivals in a nearby public hall and set up a field hospital within six days to care for patients. However, stretchers were placed too closely together in the 60-bed tent hospital to allow the use of telemedicine, Deibert said. In addition, clinicians wanted to help and volunteered on scene in sufficient numbers.
“Everyone forgot about scary and dove right in, and everything came together,” Deibert said.
Mercy has incorporated teleICU into its disaster preparedness plans. Currently, it monitors 450 patients in 14 hospitals across four states. It plans to bring online 16 additional hospitals this year and has 72 other projects.
“I’m a fan of telemedicine,” Deibert said. “We’re a high believer in telemedicine to support the health system.”
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