Katharine Moore, RN, left, Dr. Kevin Curtis and Dr. Victoria Martin on a live feed from Darthmouth-Hitchcock's Center for Connected Care.
BENNINGTON, Vt. — An emergency room patient at Southwestern Vermont Medical Center came in recently with a life-threatening cardiac arrhythmia. The attending physicians and nurses were able to resuscitate him.
While they were continuing to attend to him, his heart slipped back into the abnormal rhythm. One of the attendings noted the changes on the heart monitor, and called out, "check the monitor!"
Not an unusual situation for a fast-paced emergency department, except that the person noting the change was looking from high up through a camera — and was located two hours away at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
"[The doctor] would have seen it, maybe as long as 10 seconds later, but that's 10 seconds of missed opportunity that they picked up on right away," said Dr. Trey Dobson, chief medical officer and emergency medicine specialist. "They were able to do CPR and then shock him."
It was just an example of what the extra ears and eyes available through SVMC's telemedicine initiative can offer.
With the push of a button, doctors and nurses can tap into certified specialists in emergency medicine — both registered nurses and physicians — through Dartmouth-Hitchcock's Center for Connected Care during the day and through Avera Health, which partners with Dartmouth-Hitchcock, at night. A company called Specialist on Call is also available.
The equipment is largely a Wi-Fi-enabled monitor, a hanging microphone, and a high-definition two-way audio-video camera that can zoom in close enough to actually check someone's eye. The telemedicine team participates by monitoring and documenting what's happening, offering consultation as needed, and generally being actively involved in the diagnoses and treatment in real time.
Dobson said patients can request not to use the telemedicine team and that nothing is video recorded. However, patients have been very receptive of the idea, he said, since the initiative was launched about a month ago.
"From the very first day we turned it on, the patients have had a great experience," he said. "We leave the room, they stay on and they're really good at engaging with the patients."
Dr. Kevin Curtis, Connected Care's medical director, said the center connects with eight emergency departments, including Dartmouth-Hitchcock and SVMC. There are always doctors and registered nurses certified in emergency medicine in the center ready to help.
"Really, how we view it is we're two additional people joining the bedside team ... even though we can't really be there in person," he said over the live feed. "We have tremendous resources here."
It also allows the remote teams to collaborate with other physicians and see situations and "great practices" around the region, he said.
"It's a whole new challenge to the job and it's a lot of fun to to have a bird's-eye view of the whole room and the whole scene ... to be able to think through everything, you're not tied up with procedures or tied up with the specifics of one thing," Dr. Victoria Martin, an emergency physician at Connected Care, said. "You're able to look at the case in a broader sense and kind of keep an eye on things. ... It's a different type of medicine than being at the bedside."
The on-scene and long-distance doctors are getting to know each other, and bounce ideas as though they're all in the room together, said Dobson.
The help can vary from strictly documentation — freeing up a nurse to treat another patient — to offering consultation to doing the calls and paperwork for transfers to picking up the phone and letting the front desk know the patient needs a blanket.
SVMC is currently using emergency telemedicine in two resuscitation rooms in the ER and has a mobile cart-based setup for neurology, which benefits patients because the hospital doesn't have a neurologist available 24 hours a day.
Avera eCare, based in South Dakota, covers some 330 sites across the nation and says it's saved $188 million in health care costs by providing 24-hour service to its largely small-hospital client base with specialties and support they would not normally have access to.
"The future is here," Thomas Dee, president and CEO of Southwestern Vermont Healthcare, said. "It's already being done in other parts of the country and I think it's a great advancement. ...
"It won't just be emergency medicine, it will be other services, too. There are a lot of applications, they're almost endless of how you can use this over time."
Dee and Dobson said the subscription service also offers experienced support for new doctors and access to specialties that might otherwise require transporting patients.
The next overhaul of the emergency department will take into account telemedicine needs to expand it to all rooms. Plans are already in place this fall to add it to the intensive care unit, which will have access to "intensivists," and to expand into the health care system's Northshire facility.
Dobson said the addition of ICU will allow a seamless transition for patients from the ER because an intensivist can "literally walk around the corner" and take over. The extra support also means that patients with severe cases may be able to stay at SVMC rather than be taken to a larger hospital.
There's no limit as to how often the telemedicine team can be called in. Dobson said they're keeping it flexible but noted the two rooms where the equipment is installed often has the most dire cases. The average tends to be about 5 percent and with 24,000 cases a year at SVMC, "that's a pretty good number."
"Of course, our hospital staff are all heavily involved, they tell you the ultimate decision lies right here," he said. "They're there for the consultation, the documentation, the recommendation."
The new initiative is working well, although there is still one obstacle to overcome, Dobson said.
"The biggest challenge we've had so for ... it's getting people to hit the button."
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