For patients, the intensive care unit (ICU) is a medical refuge where a team of critical care nurses, critical care physicians and other highly trained and experienced caregivers provide constant bedside care to the sickest patients. The care in ICUs is becoming more technical such that specialized ICUs are now cropping up, such as the Neonatal Intensive Care Unit (NICU) for newborns, the Pediatric Intensive Care Unit (PICU) for children, the Coronary Care Unit (CCU) or Coronary Intensive Care Unit (CICU) for patients with heart conditions, the Post Anesthesia Care Unit (PACU) for post op patients, and the Neuro Intensive Care Unit (NICU) for patients with strokes or after brain surgery. A more recent development has been the so-called “e-ICU” where monitoring and care for ICU patients is done from remote sites that are commonly hundreds of miles away. There are many obvious dangers associated with this practice.
In an eICU, the patient is monitored by video camera and electronic vital sign and cardiac monitoring. Caregivers who watch the monitors are located at a remote site and may have 50 to 100 people to monitor at a time. Unbeknownst to patients and medical malpractice lawyers alike, eICUs have been commonly used for nearly a decade, including at some major medical centers. Their use is not apparent from the medical record and patients are generally kept in the dark about the fact that they are being monitored from a remote site. Obviously, there are a lot of places for errors to occur when eICUs are used.
Hospitals using remote monitoring argue that care is improved with “two sets of eyes watching their patients,” but there is no data showing improved outcomes. Instead, malpractice attorneys recognize that this is an obvious cost-cutting measure that has nothing to do with patient safety. In fact, the practice increases the opportunities for a medical error or medical negligence to occur.
Potential problems that may occur with an eICU include failure of technology, communication errors, understaffing, over-reliance on remote caregivers, and lack of in-person bedside assessments which provide key information. The practice raises many questions. For patients, how do you advocate for a loved one when the doctor is 100 miles away? For caregivers, how long before your job is outsourced to another country, not just another county? Can physicians who are not subject to Ohio’s medical licensing requirements or the hospital’s staff bylaws, and not subject to jurisdiction in Ohio, provide care to Ohio patients? If the remote viewing center is staffed by independent contractors who have no affiliation with the hospital, who is monitoring the quality of care that they provide?
In some rural areas, eICUs may be effective in providing skilled intensivists with ICU knowledge and experience when local physicians are not available. But the justification for remote monitoring falls flat when it is used at major metropolitan hospitals in order to save the cost of having intensivists continuously present.
