Podcasts on the ALiEM Soundcloud account

ACEP E-QUAL: The Electronic ICU

 

eICU

Building on already increasing interest in telehealth, the COVID-19 pandemic accelerated the development and implementation of telemedicine services in a variety of clinical settings. In 2018, Dr. Jason Woods hosted an episode of the ACEP E-QUAL Network podcast highlighting the creation of an electronic intensive care unit (eICU) through Emory Healthcare. In this episode, Dr. Tim Buchman and Critical Care Nurse Cheryl Hiddelson share their innovative approach to delivering critical care services via telehealth. We present highlights from this discussion below.

 

 

What is an eICU?

The eICU allows for critical care oversight, without having to be on site. It provides comprehensive monitoring and data analysis and online audio or video support for patients and families. Utilizing advanced information technology (IT) platforms and approaching with a business strategy, telehealth allows for innovative ways to provide critical care services remotely.

Why is there a need for an eICU?

The US population is aging, with the number of Americans age 65 or older increasing steadily. Demand for critical care services increases with age. The availability of critical care physicians is limited in large areas of the US. Similarly, as more nurses are reaching retirement than those entering the workforce, critical care providers are becoming hard to come by. Recruiting and maintaining critical care providers is only one part of the issue, with staffing on nights, weekends, and holidays creating a constant challenge. Telehealth poses a contemporary solution to the scarcity of healthcare providers.

What does the eICU setup look like?

The eICU is akin to airline control towers. There is 24/7 coverage by nursing and physician staff, overseeing more than a hundred beds. Various screens facilitate a “sentry” role in which surveillance monitoring algorithms allow staff to detect problems possibly even before the bedside staff. The eICU integrates bedside monitor data with additional system-wide data to create different views of what is occurring in the unit being monitored. Staff can track discharge readiness and filter lists by system or condition.

Camera sessions allow for bi-directional communication with patients and families, but also for just-in-time-training with staff as well as consultation with specialists.

What unique challenges has the eICU been able to address?

  • On-site advanced practice providers (APPs) such as physician assistants, nurse-practitioners, can be supervised by critical care nurses and physicians to provide in-person care.
  • Alternative staffing from geographic areas that are in a different time zone can help fill night shifts. The Emory group used travel nurses and physicians who were stationed in Australia.
  • Distance and delay to care become irrelevant when an intensivist can be available 24/7.

What benefits have been observed with the eICU?

The Emory eICU was able to realize decreased mortality, decreased transfer rates, decreased length of stay, and an increase in patient experience metrics for the hospitals it covered compared to other local facilities. Analysis of costs suggested savings of thousands of dollars per patient and increased revenue for small community hospitals that could retain and increase their daily census of critical care patients.

Can this concept be applied to Emergency Medicine?

There may be a role in applying telehealth data monitoring to emergency department waiting rooms in an attempt to identify patients at high risk for sudden deterioration or decompensation.

Interested in more ACEP-EQUAL podcasts?

Listen to the other ACEP E-QUAL podcasts on our Soundcloud account.

Buprenorphine prescribing: The Get Waivered Initiative makes it easier to get your DEA-X Waiver

A major development in curbing the opioid epidemic is the introduction of the medication buprenorphine to address opioid addiction. Being able to prescribe this medication, however, requires a special DEA-X Waiver in the United States. Dr. Alister Martin, the Founder of the Get Waivered initiative, is working to reduce the barriers for clinicians to obtain the training and paperwork necessary to obtain this waiver. Dr. Michelle Lin talks with Dr. Martin on this podcast about the backstory of the Get Waivered program, the lowered barriers to obtaining training, and some sneak peaks on what is new on the launching pad for his program.

Interesting fact: Medical students can participate in the free DEA-X waiver training now. The certificate of completion has no expiration date and can be submitted, when eligible for this waiver license.

Podcast with Dr. Alister Martin on the Get Waivered program

Visit the Get Waivered site to learn of their upcoming online training events and hot off the press news.

Additional Reading

  • A Tale of Two Epidemics: COVID-19 and the Opioid Crisis

ACEP E-QUAL podcasts on the opioid epidemic

  1. Opioid Use Disorder (OUD) Access in the Time of COVID
  2. Transitioning to Outpatient Care in OUD
  3. Substance Use Disorder Chat
  4. Pain Management for Patients with Opioid Use Disorder
  5. Opioid Overdose Prevention & Naloxone Distribution
  6. Opioid Withdrawals & Buprenorphine in the ED
  7. Buprenorphine after Opiate Overdose Part 1
  8. Buprenorphine After Opiate Overdose Part 2
  9. Supercharging Medication Assisted Therapy (MAT) with PAs and APRNs

 

buprenorphine suboxone OUD get waivered

Disclosure: ALiEM is proud to be a collaborator with the Get Waivered Initiative. This work was funded by the Foundation for Opioid Response Efforts (FORE). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies or stance, either expressed or implied, of FORE. FORE is authorized to reproduce and distribute reprints for Foundation purposes notwithstanding any copyright notation hereon.

By |2020-11-30T14:11:47-08:00Dec 2, 2020|Podcasts, Tox & Medications|

Little Big Med Podcast: Gender Equity in Medicine

It’s time to talk about gender equity in medicine. Significant gender disparities exist in both healthcare institutions and professional societies. These disparities persist even in fields that are predominantly female, such as pediatrics. In fact, although women comprise 72.3% of active pediatricians, only 27.5% of pediatric department chairs across US medical schools are women. Why does this disparity exist? What can we do to address it? In this episode of the Little Big Med podcast, host Dr. Jason Woods discusses these questions with Dr. Nancy Spector, Professor of Pediatrics at Drexel University College of Medicine and Executive Director of the Executive Leadership in Academic Medicine (ELAM) program.

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EM Match Advice: Program Directors Reflect on the 2020 Residency Match

EM match advice residency emergency medicine

How competitive was the 2020 EM residency match? Although COVID-19 has changed some of the rules and planning for the 2020-21 residency application season, historical data still remains a helpful guide. We have updated our annual table summarizing how competitive the EM residency match was, based on National Residency Matching Program (NRMP) data.

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By |2020-06-07T01:19:27-07:00Jun 7, 2020|EM Match Advice, Podcasts|

EM Match Advice: COVID-19 and the 2020-21 Residency Application Season

em match advice covid-19 residency applicationWith so much appropriate attention focused on getting frontline emergency providers with personal protective equipment in the COVID-19 era, one major overshadowed storyline is the uncertainty of the 2020-21 interview season for medical students applying into Emergency Medicine (EM). COVID-19 has thrown a wrench in the entire application season not only for medical students, but also medical schools, residency programs, and hospitals. The downstream effects of potentially canceling visiting (away) EM rotations and possibly even home EM rotations in the near term are dizzying. How does one obtain enough letters of recommendation? Should I even apply for visiting EM rotations? Fortunately, an experienced panel of EM program directors joins Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF) in discussing the thought processes, ongoing nuanced discussions, early available resources, and general mindset for the 2020-11 season.

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By |2020-04-20T19:46:54-07:00Apr 4, 2020|COVID19, EM Match Advice, Podcasts|

EM Fellowship Match Advice: Medical Education Fellowship

EM match advice medical education fellowshipOne of the more popular fellowships in Emergency Medicine (EM) is the Medical Education Fellowship. These fellowships come in 1- and 2-year formats and some also come with an advanced degree. What do typical medical education and medical education scholarship fellowships typically entail? What are the logistics and timing when you decide to apply? Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF), this podcast with 3 esteemed fellowship directors help provide some much-needed guidance.

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By |2020-04-20T19:47:05-07:00Feb 28, 2020|EM Match Advice, Podcasts|

EM Match Advice: Deep Dive into the SLOE

em match advice deep dive sloe

A high-stakes component in a medical student’s application for an emergency medicine (EM) residency is the Standard Letter of Evaluation, or SLOE. This is a standardized templated letter, written by an group (e.g. department) or faculty from an EM-residency program. This episode of EM Match Advice gives a behind-the-scenes peek into what letter writers are thinking and a deeper dive into the mechanics of the SLOE.

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By |2020-04-20T19:46:55-07:00Dec 6, 2019|EM Match Advice, Podcasts|
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