Novel Improvement Project: EHC Teams Monitor EHC Patients from Sydney, Australia

November 2016

"Why did we go to Australia?" asks Timothy Buchman, PhD, MD, founding director of the Emory Critical Care Center. "To literally turn night into day, and to allow our care to be more effective, more accurate, and more precise."

Dr. Buchman is referring to "Turning Night into Day: Transcontinental Provision of Telehealth by and for the Emory Community," a pilot program that recently completed 18 months of prep and has commenced activities at Macquarie University's MQ Health in Sydney, Australia. The project was developed by Dr. Buchman and Cheryl Hiddleson, MSN, RN, director of the Emory Electronic Intensive Care Unit (eICU) Center, and is an inspired solution to two of the most salient deficiencies of critical care night staffing: the shortage of senior clinicians willing to cover night shifts, and the toll that working nights can take on caretakers and their attention levels.

The study will rotate Emory critical care clinical staff who deliver remote care from Emory's eICU to an eICU at Macquarie to monitor Emory Healthcare (EHC) ICU patients during EHC nightshifts, and will determine whether providing care during the Australian daytime is more efficient and exact than providing care during the night in the United States. Data will be compiled to evaluate whether this temporary relocation will lead to greater job satisfaction, reduced physiologic stress, and improved performance. The final aim is to improve the outcomes of high-risk patients in greatest need of constant observation.

Emory's eICU has been operating since 2014, and involves telemedicine software and hardware provided by Philips Healthcare that connects ICUs throughout the EHC system and at East Georgia Regional Medical Center in Statesboro, GA, to the central eICU in the Doctor's Center Building on the campus of Emory Saint Joseph's Hospital, allowing the eICU clinician teams to work closely with providers in the member ICUs in treating patients. For the Emory-Australia project, Emory's teams will monitor and communicate with the EHC ICUs from the Phillips-installed eICU at Macquarie. The expectation is that combining daytime critical care coverage in Atlanta with night-time coverage from Sydney will yield focused, 24-hour-a-day management of ICU patients by critical care specialists, potentially decreasing the risk of complications, shortening patients' length of stay, and saving lives.   

This initial phase will inform the Australian unit's eventual deployment by Australian clinicians to connect with Australian patients in need across regional and remote areas.

"In Australia, these types of technologies also have far-reaching potential to support care of rural and remote patients," Dr. Buchman says. "Currently the optimal medical treatment there, in a stressful setting such as the ICU, can be thousands of miles away. The introduction of electronically-delivered specialist care has the potential to standardize the quality of care between the hospital and the countryside."

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