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Hospital trial turns night into day for US doctors, patients

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Picture: Dr Timothy Buchman talks to a colleague in Atlanta from the ‘Turning Night Into Day’ centre at Macquarie University 

Night has become day for a group of US doctors and critical care nurses, who are using new technology to remotely monitor their intensive care patients in hospitals in Atlanta from a Sydney health campus.

The intensivists and nurses from US health provider Emory Healthcare are part of a clinical trial to assess the health benefits for both patients and doctors of having highly experienced clinicians available to provide senior support around the clock.

Taking advantage of remote intensive care unit (eICU) technology and the 14-hour time difference, the medical teams are essentially working the Atlanta night shift during the day in Sydney.

“We’re in Australia because we are trying to look at a different model of care,” Cheryl Hiddleson, the director of Emory’s eICU Centre, told Australian Medicine.

“We were having our clinicians up all night while they were trying to do other things during the day – that’s just what happens. We know that working the night shift is tough.

“This study is to look at our staff and see how the difference in the times that they are working makes to their performance and their health.”

Under the trial, senior intensivists and critical care nurses from Emory are based in Sydney for six to eight week rotations.

They work at MQ Health at Macquarie University, using eICU technology developed by health technology maker Royal Philips, to provide continuous night-time critical care oversight to high-risk patients in Emory’s six hospitals across the state of Georgia.

“We intensive care folk have one mission, and that’s to deliver the right care for the right patients at the right time,” Dr Timothy Buchman, the chief of Emory’s Critical Care Services, said.

“Almost everything we do has to be done with both speed and care. That’s easy in a big hospital at 10am on a Monday, but that task becomes a lot harder in a remote or rural hospital at unsocial hours – on weekends, holiday, or especially at night.

“There are fewer people, and less experienced people, and patients can become sicker around the clock. Patients and their families deserve the best care, and this is about bringing that senior support to the bedside.”

The day before Dr Buchman spoke to Australian Medicine, he helped treat a patient who had been airlifted to one of Emory’s Atlanta hospitals at 2am US time – 4pm in Sydney.

The patient was suffering severe pancreatitis and respiratory failure, and was being treated by a relatively junior doctor.

“I had a complete echo of the bedside monitor, and was able to guide the doctor through the treatment,” Dr Buchman said.

“The attending physician would have been at home, probably asleep. But I was able to go in as if I was there and help implement care plans.”

Two hours later, another patient came in from a smaller hospital, suffering post-operative haemorrhaging.

“She was deeply anaemic, but she was also a Jehovah’s Witness and so was refusing blood products,” Dr Buchman said.

“The other hospital said we needed experimental therapies, so we accepted her admission. I was able to evaluate her remotely and provide the level of care she needed. When I came in to work this morning, I was able to check on her condition again.”

The previous night, just before 1am, the family of a terminally ill cancer patient, who had been intubated earlier in the day, requested a meeting to evaluate his care.

“I was able to talk to them – they could see me, I could see them – and they decided to shift from aggressive care to comfort,” Dr Buchman said.

“The patient was able to die. His family were able to be there and it was able to occur in a timely fashion. The family had come to a decision and acceptance, and they could have that meeting when they needed it, instead of having to wait for hours.”

Emory already uses the eICU to provide senior support to smaller and remote hospitals throughout Georgia. The time difference trial is intended to see if the technology can help keep senior clinicians in the workforce.

“People do function a lot better when they can do night work in day time,” Dr Buchman said.

“This technology is important, but it is only an enabler. The people – the staff, the patients – are what is important, and this technology gives us the ability to use this accumulated wisdom during daylight for patients on the other side of the world who would not normally have access to this level of expertise.”

Maria Hawthorne