1. Sites, Frank D. MHA, RN
  2. Hanson, C. William III MD
  3. Mullen-Fortino, Margaret MSN, RN

Article Content

Background: The Penn E-lert eICU programIQ is a state-of-the-art electronic ICU (eICU) that provides an additional layer of expert medical and nursing support for critically ill patients located in the University of Pennsylvania Health System. The Penn E-lert eICU is staffed by Penn faculty intensivists from the Department of Anesthesiology and Critical Care and the Department of Internal Medicine and Surgery, as well as by experienced critical care nurses. Our mission is to establish a uniform, data-driven, benchmark critical care standard in our health system. By using trended data and intelligent software, the Penn E-lert eICU can identify early, subtle changes in a patient's condition. The eICU aims to improve patient mortality and hospital length of stay (LOS) using the eICU telemedicine program and to improve cultural and institutional change across the health system.


Methods: Implementation of the eICU program involved installation of an eICU software package across the health system, conversion to an all electronic bedside documentation system, and development of new care paradigms including eICU communications with the bedside team. A precedent was developed for eICU personnel in their involvement with patient care. Interinstitutional standards were developed for critical care benchmarks: quality and safety. Workflow processes were developed around the newly implemented technology for MD and RN electronic medical record documentation.


Results: Unit A, a 24-bed surgical ICU, has shown a marked improvement in observed and predicted ICU LOS and mortality despite a rising case mix index (CMI). Units B and E saw improvements in observed and predicted ICU mortality. Units C and D remain unchanged or regressed since implementation of the eICU program.


Conclusions: Variations in individual unit governance are proving to be more challenging than the technology itself. Individual unit successes are evident, in which physician acceptance and engagement are strong. An agreed upon strategic roadmap for individual units with the key physician and nursing stakeholders needed to market and deliver the process is essential for obtaining measurable outcomes. When the eICU system is used in the clinical setting to document and oversee patients in the ICU, transparent documentation and staff acceptance may prove to be the most important indicators for successful implementation. Further study is needed to determine conclusively the variations from unit to unit and hospital to hospital in the use of eICU telemedicine programs.