Introduction: An electronic ICU (eICU) contributes to improved patient outcomes through utilization of alerting systems designed to address variance in clinical parameters and detect early physiologic deterioration, allowing for early clinician intervention. An eICU system was implemented in our institution in 2016 with three main purposes: Off-site continuous monitoring through computerized surveillance of physiologic and laboratory data, standardization of care through implementation and oversight of best practice protocols, and intervention through bedside teleconferencing. We present our 18-month experience with aneurysmal subarachnoid hemorrhage (aSAH) patients.
Methods: Based on evidence based guidelines, best practice protocols for venous thromboembolism (VTE) prophylaxis, stress ulcer prophylaxis (SUP) and lung protective mechanical ventilation (ARDSnet-MV) were implemented beginning in Q1 2016. eICU centrally monitored adherence with best practices and interacted daily with the Neuro-ICU bedside team to ensure compliance with each. The data for patients with the diagnosis of aSAH were analyzed.
Results: Data was collected between Q1 of 2016 and Q3 of 2017. During this time period 94 patients were admitted to the neuro-ICU with a diagnosis of aSAH. In the aSAH subgroup, implementation of eICU support in the Neuro-ICU increased SUP compliance rates from 94% to 100%. ARDSnet targeted two different patient populations based on oxygenation ratios (OR): for patients with OR of <300 we improved low tidal volume ventilation rates from 35% to 86%. For patients with OR>300 we improved tidal volume rates of <10ml/kg IBW from 96% to 100%. VTE prophylaxis compliance was maintained at 100%.
Conclusions: Preliminary data from the eICU program demonstrates marked improvement in best practice compliance with emphasis on VTE prophylaxis, SUP, and ARDSnet-MV. Future eICU protocols will continually track additional modifiable parameters associated with morbidity in aSAH including serum sodium, glucose, white blood cell count, volume status, and duration of mechanical ventilation to help improve patient outcomes.
Patient Care: Future eICU protocols will continually track additional modifiable parameters associated with morbidity in aSAH including serum sodium, glucose, white blood cell count, volume status, and duration of mechanical ventilation to help improve patient outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) define telemedicine, 2) identify the utility of telemedicine in the critical care setting, 3) understand the need for continuous monitoring of physiologic parameters in aneurysmal subarachnoid hemorrhage patients, 4) describe the utility of telemedicine/eICU in managing aneurysmal subarachnoid hemorrhage