very hospital intensive care unit has its
moments of high drama, but this one
was especially dramatic.
An ICU nurse at North Colorado Medical
Center in Greeley, Colorado, checked in on
one of her patients, who was on a ventilator
and whose vital signs all looked fine. But the
nurse had a feeling something was wrong.
She contacted the Banner doctor who also
was monitoring the patient from more than
800 miles away.
Banner’s eICU™ operations center, known
as iCareTM, located in Mesa, Arizona,
monitors Banner Health’s ICU patients in 20
Banner hospitals across five states. Twentyfour hours a day, seven days a week,
physicians and nurses in iCare monitor
patients in 430 ICU beds – not replacing
the nurses and physicians at the patients’
bedsides, but backing them up.
Together, the bedside nurse at Colorado
Medical Center and the eICU doctor began
assessing the patient. Stat lab tests and
X-rays were ordered.
Suddenly, the patient started to crash.
The X-ray arrived, showing a tension
pneumothorax – the lung was leaking
air into the chest cavity, resulting in
compression of vessels returning blood to
the heart, which can be fatal if not treated
immediately. A hands-on physician was
needed, but there were two codes in the
emergency department and three surgical
cases in process. The only available
physician was a family medicine resident,
on his first day in the ICU.
The eICU doctor talked the resident through
the steps of relieving the pressure by
inserting a large needle into the chest. The
patient immediately began to breathe easier
and his oxygen saturation moved out of the
danger zone. When the surgeon finished her
OR case, she came down and inserted a
“The patient’s vital signs returned to normal
and he was discharged two days later,”
says Deborah Dahl, Banner’s vice president
for patient care innovation. She oversees
Banner’s telemedicine operations.
“This is an example of why I love coming to
work in the morning,” Ms. Dahl says. “We
not only have the opportunity to change the
way health care is delivered, and at Banner
Health, we are taking full advantage of that
Beginning in February 2006, Banner was
one of the early adopters of Philips eICU
technology. Combining the eICU technology
with Banner clinicians and standardized
processes has made a difference in
“We have the
opportunity to change
the way health care is
Banner Vice President
Over the past two years, Banner’s ICU
mortality rates have been among the lowest
in the country, Ms. Dahl says. In 2012, ICU
actual length of stay was 20,000 fewer
days than predicted based on patient acuity,
and total hospital days were reduced by
49,000. Costs avoided totaled more than
Each of Banner’s ICU rooms is equipped
with a fixed, two-way audio-video system.
The bedside monitor sends real-time,
continuous vital signs to the Philips system,
while the electronic medical record interface
sends lab results, medication orders, and
other pertinent information from the bedside
In Banner’s iCare control room, the team of
physicians and RNs works 12-hour shifts.
The eICU technology can recognize possible
adverse trends and alert the iCare team
member who is monitoring that patient.
For example, if a patient’s heart rate goes
up from 70 to 74 to 78, that’s within
normal limits. “But the eICU system says
‘Hmmm. The heart rate is drifting up, the
blood pressure is drifting down, there may
be something going on here,” Ms. Dahl
explains. The system does a rapid analysis
and alerts the nurse or physician that there
may be a problem.
“We’re looking for anything that might be
a potential problem, so we can intervene
before it becomes a major problem,” says
Mary Cartner, an iCare nurse.
She can use her camera to get a close-up
view of a patient and make an assessment.
She also can assist the bedside nurse with
routine things like verifying the name on the
wristband and making sure it matches the
information on a blood bag. She can look
in-depth at a single patient’s information or
scan information from a block of patients.
Bhavish Shah, MD, a critical-care specialist
who spends one week a month in iCare –
the rest of the time he’s in his home state
of New Hampshire – considers iCare state
of the art.
“In the hospital, I can follow 10 patients a
day,” Dr. Shah says. “Here I can follow 400.
In iCare, my role is to respond to requests
for help from the bedside, look for adverse
trends and intervene before those adverse
trends become adverse outcomes and
assure that every patient is receiving the
evidence-based practices they need.”
Banner Health has recently expanded its
telemedicine capabilities to include noncritical inpatients at two of its hospitals,
Banner Gateway Medical Center in Gilbert
and Banner Ironwood Medical Center in
Queen Creek. Banner also now provides
in-home services for patients living in
the northwest Phoenix area with multiple
chronic conditions and a history of repeated
“Five percent of the population accounts for
more than 50 percent of the health-care
costs in the U.S.,” Ms. Dahl says. “No one
has ever said, ‘I wish I could spend more
time as a hospital patient.’ We’re working
to improve our patients’ quality of life, while
reducing hospital visits and lowering the
cost of health care. Although it’s early in the
program, we’re pleased with the results.”