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COVID-19 fast-tracks new critical care model at OHSU Health

Virtual intensive care units allow safe, secure care for Oregonians
man typing on a keyboard, with a large set of computer screens in front of him
Marshall Lee, M.D., says the virtual ICU model allows telemedicine providers to see data in real time and work jointly with the bedside team. (OHSU/Jennifer Smith)

Patients in an intensive care unit, or ICU, are critically ill and receive the highest level of care in a hospital.

During a pandemic – whether to maintain isolation, preserve protective equipment or due to a shortage of health care workers – the traditional bedside care delivery model is not always possible.

When the COVID-19 outbreak threatened to overwhelm the ICU bed capacity in Oregon, OHSU Health moved quickly to accelerate its work previously underway to implement a virtual ICU (VICU). Now, all 90 ICU beds at OHSU Hospital and Hillsboro Medical Center, an OHSU partner, are connected through audiovisual equipment and a comprehensive, secure data platform. The 12 ICU beds at partner hospital Adventist Health Portland are being upgraded to the platform in the next several weeks.

Joe E. Ness, M.H.A., B.S.Pharm.

“We finished the proof of concept for our virtual ICU in late 2019. When the COVID-19 crisis hit, we knew we had to act quickly as the virtual model might be needed for hundreds of Oregonians,” said Joe Ness, M.H.A., B.S.Pharm., senior vice president and chief operating officer, OHSU Health.

VICU services are currently provided by an ICU-trained physician around the clock. In addition to supporting OHSU Health hospitals at night, the team covers a growing number of rural hospitals across the state. When fully operational this summer, the VICU team will consist of an intensivist physician and critical care nurses as extensions of the primary team.

VICU can connect patients and providers in hospitals around the state

The VICU model erases geographic distance by relying on either in-room or mobile AV equipment. A team stationed at OHSU’s Center for Health & Healing 2 on the South Waterfront can collaborate with the patient’s care team to:

  • Track a patient’s vital signs
  • View ventilator and key laboratory data
  • Engage in two-way communication to round on patients
  • Assess patients, track progress and recommend treatments

OHSU co-developed with GE Healthcare a platform called Mural to make the VICU a reality. Mural helps clinicians identify changes in patient status and understand the patient’s clinical picture in real time. Data from the patient’s bedside monitors are sent securely and processed through proactive algorithms to help clinicians identify patients who are at risk for deterioration – including patients who may be on extended mechanical ventilation support due to COVID-19.

Fortunately, Oregon avoided its hospitals being overwhelmed by patients with COVID-19, due to strong actions by state authorities as well as personal and economic sacrifices by Oregon citizens and businesses. When ICU rooms being reserved for patients with COVID-19 went unused, OHSU took the opportunity to retrofit them with VICU technology.

Matthias Merkel, M.D., Ph.D.
Matthias Merkel, M.D., Ph.D.

“In the beginning of the COVID-19 pandemic, we quickly collaborated with health systems across Oregon to create visibility into how we use more than 7,500 hospital beds statewide,” said Matthias Merkel, M.D., Ph.D., senior associate chief medical officer for capacity management and patient flow, OHSU Health, referring to the COVID Capacity Center - a first-of-its-kind system that monitors 90% of all hospital beds in Oregon. “The VICU gives us an additional ability to serve Oregonians by supporting local care teams and making collaborative decisions for the benefit of the patient. As we learn how our new normal looks with COVID-19, leveraging technology to connect clinicians across our state has never been more important.”

By putting data in the hands of clinicians, the VICU empowers care teams to adapt based on evidence and improve communication. Marshall Lee, M.D., described a scenario in which the VICU team noticed a change in a patient’s heartbeat after a procedure, and was able to alert the bedside team before the monitors in the room went off.

“What is really exciting about the VICU model is that it allows telemedicine providers to see data in real time and work jointly with the bedside team to optimize patient care,” said Lee, medical director for adult critical care telemedicine at OHSU and assistant professor of anesthesiology and perioperative medicine, OHSU School of Medicine.

OHSU Health is working with hospitals and health systems throughout the region to expand the VICU model.  

The VICU is supported by Phil and Penny Knight, along with Nike CEO John Donahoe and his wife, Eileen, and Nike Chairman Mark Parker and his wife, Kathy.  

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