- The advantage of a Tele-ICU is that they simply turn on the audio visual system,
and they're at the patient's bedside.
- So we'll see how the fluid bolus works, we'll give him a few minutes,
if his blood pressure doesn't respond, then we'll give him a low dose epinephrine IV push.
Yeah and he doesn't look like he's breathing real well,
so can you call respiratory therapy to the beside?
[Over speaker] If we could grab the ambu bag and assist him with ventilation,
[Over speaker] til respiratory gets the ventilator.
[Over speaker] Diana, great job, the ICU doctors are on their way
[Over speaker] and we'll continue monitoring until he arrives.
- I'm Dr. Jonathan Siner, welcome to the InSight Tele-ICU at Yale Medicine.
Hi Robin, I just noticed the blood pressure was low,
systolic of 50s in one of the patients in room 310,
at the Medical ICU at St. Raphael's campus.
- Hi. I'm Robin Waddell, I'm a nurse practitioner here at Yale.
I've been in the Tele-ICU since August 2015 when the program launched.
- The Tele-ICU is a way of providing care remotely to critically ill patients
using two-way audio, video and remote monitoring of data.
Really, a second set of eyes and an added layer of protection for the patients.
The Tele-ICU operates from 7 p.m. to 7 a.m.
- The patients, the families and the nurses can see me on a dashboard screen in the room
and we're able to communicate the plan and update the family as needed.
- [Dr. Siner] The core of the operations is a list right here,
and this list has all the patients that we're monitoring
in the ICUs at St. Raphael's campus, the emergency departments
at the York Street St. Raphael's campus,
as well as the Medical Surgical ICU down at Greenwich Hospital.
The current technology and build in the Tele-ICU allows us to care for 56 patients at present,
but we could easily expand it to 120 patients.
Can we check in with the nurse and turn on the display?
- [Over speaker] Hello, this is Robin, the nurse practitioner with InSight.
Can I turn the camera on?
- Yes, this is Diana. - Okay, good.
- Systolic is still in the 50s.
In the old days, you would review your trend of your vital signs
and that might have happened an hour ago.
- Tele-ICU looks at all of the data available in electronic medical record,
as well as all the vital signs and other data coming in from the bedside monitor.
So, their oxygen level, their blood pressure, their heart rate,
their respiratory rate, as well as the cardiac rhythm from the electrocardiogram.
The way the scale works, a big change in blood pressure
would bump the patient way up to the top of the list immediately
and they'd go from a green to a red right away.
- If they see any change in a vital sign, they immediately notify you.
- Mobile heartbeat is an app on the phone that is secure.
So, we're able to communicate about patients,
and they're able to contact us.
We carry the phones all of the time.
Dr. Burns arrived to put the central line in.
- We'll keep the camera on and so if there's any management
that you need help with while you're doing the procedure.
- Just for a recap, we're bagging him
and we'll place him back on the ventilator.
If you need anything else from us, just let us know.
We're available.
I'm gonna camera out.