When Technology Meets Compassion

In this episode of We Talk Health, we take a closer look at how innovative technology and compassionate care come together through West Tennessee Healthcare’s eICU program.

Host Keith Sherley is joined by Jason and Audrey, members of the eICU leadership team, to discuss what eICU really means, how it works behind the scenes, and the impact it has on patients, families, and bedside care teams across our region.

From real-time patient monitoring and rapid response support to helping patients stay closer to home, this conversation explores how eICU adds an extra layer of expertise and collaboration in critical care settings. Listeners will also hear about the day-to-day role of eICU nurses, how the technology supports patient-centered care, and what the future may hold for this growing program.

Whether you are a healthcare professional, patient, or community member, this episode offers an inside look at how West Tennessee Healthcare is using technology to strengthen care and improve outcomes across West Tennessee.

Transcript

SPEAKER_02 0:30

Hello, this is We Talk Health, and I'm Keith Shirley. Glad you're with us today. Very special guests, and you're going to want to pay attention because there's going to be a lot of information coming out here. This is very important work. The EICU that's going on here at West Tennessee Healthcare. And I'm going to let my guests introduce themselves. Who are you?

SPEAKER_01 0:52

My name is Jason Cottle. Hi Jason. I'm an EICU nurse with West Tennessee Healthcare. I've been uh an employee with West Tennessee Healthcare since 2009. Started prior to nursing in the ER. Um, I've been an ICU nurse since 2011 with West Tennessee Healthcare. Um left them for a little while, traveled for about five years, but I came back in 2023 to CCU and had the opportunity to come over and work for Audrey in the EICU uh in February of this year. Audrey.

SPEAKER_00 1:27

Hi.

SPEAKER_02 1:28

Hi, tell me about yourself.

SPEAKER_00 1:30

I am Audrey Trammell. I'm the director of remote patient monitoring here at West Tennessee Healthcare. Um that encompasses not only the EICU, but also our centralized monitoring unit and virtual care. Um I have uh been with West Tennessee Healthcare since 2008, um, was a nurse on a cardiac progressive floor, and then transferred to the C VICU. Um, and then I worked in case management for a couple years, and I left for a couple years and um came back in 2023, uh, worked in C V ICU prior to um transferring over to remote patient monitoring.

SPEAKER_02 2:10

What is EICU? The little is and it's a little E.

SPEAKER_00 2:15

Yes.

SPEAKER_02 2:16

Why is that?

SPEAKER_00 2:17

Um that stands for electronic.

SPEAKER_02 2:19

Okay.

SPEAKER_00 2:20

Um and so it is a virtual ICU where we are located off of the main hospital campus. Uh we are actually in uh the system support building um out by the ballpark. And um we are able to use two-way audiovisual equipment to remote into patients' rooms. Um, and then we have our own platform um called eCare Manager, where it does a whole lot of fancy things um and it runs the it runs patients' um numbers and vital signs and lab work through and comes up with predictions on um do they think this patient is ready for discharge? Um what is the the chance of mortality? It picks up on microtrends. Um so it it's constantly evaluating where the patient's vital signs are and um where the patient's lab work is to be able to make predictions.

SPEAKER_02 3:26

Jason, no offense. This sounds like it's doing your job.

SPEAKER_01 3:30

It it it does, but it's it still takes a mastermind behind the curtain. Okay, where do you fit in into that? Well, I'm I'm I'm the wizard behind the curtain. Okay. Okay. Tell me about that. Well, we come in, we well, first of all, I mean it's I'm I'm techie. I'm a little nerdy, so I love this. It's it's it's like the it the intersection of where healthcare meets uh uh modern technology. Okay. And I love that. So it's pulling algorithms in from Philips and from Epic. A lot of the different uh what does that mean? Epic is a platform where we chart all of our patient information, it's where their their um um electronic uh medical records are stored. Okay. Um private privilege healthcare information, of course, obviously secured, but um um Phillips is like our monitoring systems, like where you can see their vital signs and things trending. So this this e-care manager that Audrey mentioned, that's pulling in all these algorithm is pulling in these algorithms from these two different platforms. And I'm I'm I'm just the monkey turning the wheels. I'm looking uh it it honestly, it's intuitive. Um, and that that's why it does require, and one of the requirements is that you have an extensive ICU background. With that background, the the mechanics are very intuitive. Um they they they make sense because you've seen them all your career. Okay. So you're watching these numbers, you're watching these trends, and and like Audrey said, it's giving you um predictability factors such as discharge readiness. You know, we hopefully we can help shorten up some of these ICU stays. We're we're watching these numbers. Hopefully, we can help uh with the the mortality rate predictions, we can help see when a patient's going bad before they truly get there. It's almost like a crystal ball, if you will, where we're looking and we're seeing what the outcomes, the possible outcomes are, and we're making sure that that the information is in the hands of the bedside nurses and the intensivists that need that information to help care for the patient. We're just an extra layer of support for those patients.

SPEAKER_02 5:40

Okay. So for those listening that are inquisitive as I am, but not particularly nerdy and not medically inclined, I want to ask some simple questions. And let's start with why is it important that you be able to monitor and not be or does is it important that you can monitor and not be on site? Because the first thing you said is we do this all with cameras and I guess following equipment and things that they're hooked up to. Why is it important that you not be on site, or does that matter?

SPEAKER_00 6:17

Well, um, we have the advantage of being able to monitor patients at Jackson-Madison County General Hospital, Dyersburg patients, Mylan patients, Martin patients, Camden, and Bolivar. Um so us being at a a central location in our own little hub, um, we're not necessarily tied with any particular hospital. We're more for the support for the system.

SPEAKER_02 6:47

So what does that mean to efficiency and also effectiveness? I would think the efficiency comes in that you can monitor more than one hospital. So you don't have to have bodies physically at all of these ICUs around. So you can get you can be efficient. So is there an efficiency and is there an effectiveness to it? Does it improve the server, the the quality of care?

SPEAKER_00 7:14

Um it is very efficient. The um e ICU model is a complement model to ICU care. Uh we are not a replacement in any way. Um so in in the EIC or in uh bedside ICU, um, typical nurse-patient ratio would be two patients to every one nurse. In the e-ICU, we can handle anywhere from 30 to 50 patients per nurse. So we're we we're the 30,000-foot view, which allows us to to have those higher nurse-patient ratios.

SPEAKER_02 7:50

Jason, how do you have you been a bedside ICU nurse?

SPEAKER_01 7:56

Absolutely. For going on 15 years, I w I was a bedside ICU nurse nurse. Is it important for the job that you do to have had that experience? Absolutely. You got I I could not be uh the shepherd of of this information without the knowledge that I gained from bedside.

SPEAKER_02 8:16

Are you one of the nurses that she's that that Audrey's talking about that handles so many more patients electronically? Trevor Burrus, Jr.

SPEAKER_01 8:25

That's correct. That's correct. I have on on a like Audrey said, I could handle from 30 to 50 patients that I could be monitoring at at any time, at any given time from various locations across West Tennessee Healthcare.

SPEAKER_02 8:40

Okay. What does that monitoring actually look like? And do you communicate with the nurses or do they come back and look at a wall, or are we on the USS Enterprise? This is Captain Kirk. How are we actually making this work?

SPEAKER_01 8:56

Well, I'm I'm beaming in over their TV. Okay. Um But I we have we have several different modes of communication with the bedside nurse. Um obviously there's still uh the landlines, telephones. Uh we have a secure chat through one of the uh through the EMR. Um and then also we have video. We have the A V function, the video chat that we we we come in through uh the television equipment's there with the cameras, speakers, um, we can communicate with them in that respect as well. In the room. In the room. Okay. And the patient is Absolutely. The patient, I mean, we we round on all of our patients once a day. Um uh obviously we try to round uh uh by acuity. So when we come in, these numbers that are running, we can trend them by our highest acuity, um, which is called our automated acuity. Then we also have an automated acuity trend, which we call our delta score. Um, those are the ones that are the sickest, the ones that are acuity. Acuity sick, the sickest patient and the patient that's getting that that is um like digressing, getting worse, uh, to put it maybe in layman's terms, worse, but we call that a delta score, uh uh automated acuity trend. And that's the way I sort mine when I'm setting my day up. And I try to round on those patients first. Those are the patients that um that look like they need my attention the most. Um it's not that the bedside nurse doesn't see them because they do an outstanding job with CNSC Healthcare has an amazing staff, and every ICU that I've ever been a part of is is uh uh um stocked with great ICU nurses. So it's not that that I'm doing anything any different than they could do. Um, it's just that I'm another set of hands doing it. Uh I'm an extra resource. Um sometimes some days are busy for the bedside nurse. Um it it would be nice just coming from the bedside myself to have had somebody keeping an extra eye on my patients. Hey, did you see these labs? Hey, did you notice that this heart rate is trending up? This patient appears to be sicker on paper. My camera did in the room, this patient doesn't look well.

SPEAKER_02 11:20

You know, and we're so the heart rate trending up. That that may be an example that I let me jump in there and ask you about that, Jason. So when the the bedside nurse comes in, she gets a snapshot of what the patient's vitals are at that moment. Something might have happened five minutes before, ten minutes before she came in overnight, and she can't sit there and read that whole tape like a ticker tape can. Your equipment, Audrey, your equipment that you have that you provide for the JSONs, they're reading those. The computer is monitoring all those things. Is that correct?

SPEAKER_00 12:02

Yes. Um continuously 24-7 throughout the entire ICU stay.

SPEAKER_02 12:07

Okay. And that equipment that's monitoring the patient's heart rate and labs and vitals and I guess respiration and you know how how comfortably they're resting or whatever those things are, those get analyzed by equipment. And then Jason, somebody like you, looks at that and go, hey, telling the bedside nurse this is what's went on here overnight.

SPEAKER_01 12:34

Exactly. And it's not information that they don't have readily abundant at their fingertips as well. If they're in the ICU, they're on a monitor, those nurses see the same thing we're seeing. But that's the beauty of technology, is that they're at the bedside. I'm at, as Audrey said, our our uh remote location, and I can see the same things. I can see the same trends, I can see the same in real-time vital signs that let me know how this patient's you know doing. Are they are they trending up? Are they trending down? Are they getting sicker? Are they getting better? Um, and these are all things that uh like I said, I'm I'm an extra layer support, I'm another set of eyes, um, I'm another highly trained ICU nurse that is just there to help support their care.

SPEAKER_02 13:22

Audrey would this be the equivalent of having a nurse sitting by each bed watching everything as your Jasons, all the Jasons that you have can go back and look at this, that the equipment itself is bedside all the time reading whatever's going on and giving you that information that a bedside nurse can't do because they're moving constantly.

SPEAKER_00 13:52

Yeah, that's exactly it. Um it's in the background. It's it's always there constantly um evaluating, um doing surveillance on what the vital signs are. Um, and then we have an extra advantage where if we do see something, we can remote into the room via the camera to see does it match, is what the computer's telling us match what is actually going on with the patient. Or it could be that is this a time we need to reach out to the bedside team immediately. Uh so it gives us the you know information. Technology has its limitations, um, but uh that's exactly what it is. It's it's constantly watching all of those micro trends. Our technology um allows for it to run through algorithms and make predictions. That's the biggest piece of what it is. Um they're taking each patient's data and comparing it to thousands and thousands of other patients um to make a determination. Is this patient ready to discharge from the ICU? Is this patient um likely to um get worse over the next 24 hours? And so it just kind of helps us see um see things that are happening maybe before they happen.

SPEAKER_01 15:11

We're we're and and and and and like Audrey said earlier, we're we're not there as a replacement. We are basically an extension of that bedside nurse, um, obviously with limitations being remote, but we are an extension. Um we are there monitoring uh like like Audrey said, those labs, those trends, that patient's progress, whether it's better or worse. Um, but we are just an extension and uh a supporting factor for that bedside team.

SPEAKER_02 15:42

Okay, so is this going on right now in all of the ICUs across the West Tennessee healthcare system?

SPEAKER_00 15:49

So right now we are currently live in Dyersburg, Martin, Mylan. Um, and then we have carts in the emergency departments that are connected to the EICU at um those three hospitals and Bolivar in Camden. And then um we are live in the SICU here at Jackson and um the MICU.

SPEAKER_02 16:14

ICU too.

SPEAKER_00 16:15

What M S what uh the surgical ICU and the medical ICU.

SPEAKER_02 16:20

Okay. Surgical, I might have gotten medical, I would have gone maternity. I don't know why. That's just the thing that popped in there I thought about. Okay, so which of you wants to field this question, or maybe both of you might have an opinion, and that is how does all of this equate or affect patient care? As a as an ICU patient, how does this affect my quality of care?

SPEAKER_00 16:45

Honestly, it probably depends on your location, partially. Um, if you are in one of the community hospitals, um it does connect you to um uh another set of um experienced um healthcare providers. Um, and then hopefully it will either have patients to stay in the ICUs in the community hospitals or be transferred sooner from the community hospitals um to maybe here at Jackson or somewhere else. Um for our ERs, where we are able to um use the AV equipment and e-care manager, um, the whole EICU, uh, that also allows for an extra set of eyes in the most critical patients at our community hospitals that may be waiting on transport, or um maybe they want to connect the patient with the EICU to determine is transporting that patient appropriate, or is it more appropriate to allow this patient to stay in the community hospital? Um, patients and families, you know, Jackson is not a close drive for everyone. Um, so we're hopeful that this technology and um this level of care will allow some patients to be able to stay in the the hospital that's closest to their community.

SPEAKER_02 18:12

You've been bedside, you now do this. How do you see this as impacting patient care?

SPEAKER_01 18:20

When you're talking with your patients, when I was a bedside nurse, um a lot of them, you know, when you ask them about their their hopes, their goals of for their health care stay, um, a lot of them say, I want to get back home to my dogs, I want to get back home to my family, I want to be so like Audrey said, I I think this impacts the the community uh by being able to for those patients that we are able to keep them closer to home. Um family members don't have to make an hour and a half drive to Jackson to come see them. They can drive down the street to the local, to the to the hospital there uh in their community and see them. Um I think that makes a big difference. And a lot of times we all know uh mindset plays a lot in in recovery and healthcare. Um you see patients who are motivated to get better generally get better quicker. Um I think patients who who have that, I think we're we're allowing them something they didn't have before, and that's the opportunity to receive the mission statement that West Tennessee Healthcare has, right? Competent, compassionate um health care right there in their community without having to be transferred to Jackson to do it. That's that's one of the goals of like Audrey said, that hopefully we can allow them to be able to stay there in their community and help them, keep them there and and still get that competent, compassionate uh health health care.

SPEAKER_02 19:47

What is the day in the life of an ICU patient like?

SPEAKER_01 19:53

You know, they it it it it varies. Um we we talked about acuity earlier, which is like how sick they are. There's no sleep in a hospital. So really a day, I mean you you've got nurses in and out, 24-7, um, coming in, whether it's to um take temperatures, do assessments, uh draw labs, uh bring medicine, uh, check on the patient. We notice you you might notice a trend in in vital signs where you want to lay eyes on the patient. You go in and you look at them. So a day in the life of an ICU patient is is is it's hectic. You know, there's a lot of there's not much sleep in the hospital. Fear. Absolutely. I mean anxiety. You're taking care of people in the in some of the most vulnerable situation, you know, times in their lives. And I know I've never taken that for granted. Um, that's one thing I always try to keep in the forefront of my mind is that I'm caring for somebody in probably one of the more vulnerable times in their lives. Um, fear is definitely uh plays a part in some of their minds. Anxiety, the the what-ifs that we can all do in in any any aspect of life, especially if you're in a hospital and you're sick and you've just been told that you have a disease process that maybe you know very little about or are not at all. So yeah, we're we're we're there to be that compassionate, competent. We're we're we're the keepers at the door, the nurses are. So we're we're there to make sure they get the care, they get it compassionately, but then that we also make sure that they understand the information, that they understand doctor goes in and talks to them like, hey, did you understand all of that? Did you have any questions? Um, we're the facilitators, if you if you will, of uh of um making sure those patients understand their health care, what they're getting, how they're being treated, how it's going to affect their life moving forward. Upon discharge, we do discharge paperwork with them that we talk about healthy diets, healthy lifestyle. The changes in their lifestyle. And then these are these are all things that the ICU patient, you know, that that's these are things that they're going to experience while they're in the hospital.

SPEAKER_00 22:11

Can I add I have something to add? Please do. To uh how we're impactful. The EICU, um, not only are we uh, you know, in the background with the surveillance and all that type of things, we're also trying to offload tasks from the bedside nurses and the bedside teams. So um, say you have a patient that is critically, critically ill, um, and all of the nurses on that pod need to be with that patient at that time. We now have the uh availability to have eyes on all the other patients in that pod at the same time. So they're being watched, whereas not that they weren't being watched before, it's just there there's just an immediate person there with them.

SPEAKER_02 22:59

You've you've got oversight that means that other patients don't have to sacrifice their quality of care. Their quality of care is not going to be sacrificed or impeded or interfered with if for whatever time every physical nurse needs to be bedside with somebody else. These n these patients are still being cared for and monitored and watched in every way, just as they were.

SPEAKER_00 23:23

Right. And, you know, I I worked bedside as a nurse for a long time, um, like Jason, and I know I would feel better if I was with the most critical patient at a time and and the whole team needed to be there, the bedside team needed to be there. I would feel better knowing that there was another experienced nurse able to uh watch over my my other patients.

SPEAKER_02 23:46

One thing that we I I don't want to let you get away without at least touching on. And last week I got a letter telling me that my data had been compromised in some way in two years before they got the letter. By the way, I got the letter two years later. Like two years ago this happened. Okay. Thank you. So what about privacy? There's a lot of technology and a lot of fiber optics, a lot of cable running between this. What about fiber uh privacy and security?

SPEAKER_00 24:16

Sure. Um we are in a secure location. So, you know, we're not we we don't have um the public constantly walking uh past our workstations. Um we utilize the uh electronic medical record and we follow all HIPAA um guidelines and protocols. Um I know there's been a lot of concerns about the AV equipment. You know, you have someone that's remoting into the room and you may be in a um vulnerable position that you wouldn't necessarily want uh someone to be cameraing into your room at that time. Um the nurses are are very experienced and um they are also communicating with the bedside teams. So the bedside teams have been great to say, hey, we're gonna give uh this patient a bath. Please don't camera in for the next 30 minutes. Hey, we're gonna be doing this uh procedure. Can you not camera in for the next hour? Um things like that and just just that communication. Um and then of course if if the nurse does camera in and it's it's not a good time, um, the nurse will uh politely remove themselves from the room.

SPEAKER_01 25:28

And we have a privacy feature that lets us click not to camera in. So if there's two or three of uh uh us, the EICU nurses there, not just I see it, if it was my patient, but like m my colleagues can see it as well, so we all know you know not to pr not to go into that room at this time. They've requested privacy. So we we have that filter for our uh AV technology.

SPEAKER_02 25:54

Some of us are gonna know someone who's been an ICU or who's gonna be an ICU, and this is a lot of information that helps because it takes the strain off of some. They don't have to leave the familiarity of where they are to get the care that they need. Uh just I think before I let you get away, I want to ask each of you where do you see this technology going beyond where it is?

SPEAKER_00 26:22

Um I I hope that uh we'll just continue to expand. Um, there are several other um platforms and things that can be done um where you can have things like virtual sitters, you can have um virtual nurses that are able to do um discharges on the floor, things that take very time-consuming um tasks off of the bedside teams um and allow it has it's one dedicated person that would be um, you know, that you could have one nurse doing the entire floor.

SPEAKER_01 26:57

I I I really don't have a whole lot to add to that because I I I think that's where all of our hopes are that this will go. I mean, you know, the sky's the limit, technology, you know. Well, was it field of dreams? If you build it, they will come, you know. So you know, we're looking to build something that that um not only gives that competent, compassionate health care, but also inspires the patients, makes them feel like, hey, West Tennessee Healthcare has given me the absolute best in patient care uh that there is to offer. And so that's what we just want to we want to build on that and how far it grows. You know, that sky's the limit, I I believe.

unknown 27:37

Yeah.

SPEAKER_02 27:37

Thank you both. Thank you both for being here. Thank you for everything that you do and for letting us know here at We Talk Health, kind of the the present and the future of where this is going. You had one more thought.

SPEAKER_00 27:50

Well, I was just gonna um say um this technology has been around for 25 plus years. Um so we're very excited that we were able to bring it here to um West Tennessee and um to the West Tennessee healthcare system.

SPEAKER_02 28:05

I want to thank you both also for the service that you've given to the community as health care providers. It's a stressful and highly uh anxiety. I mean, you have your own anxieties, you see a lot that you have to forget and deal with, and a lot that you can't take home and in and in the course of your jobs, you can't even talk to anybody about it because you can't really share what this particular process or patient went through. So thank you for everything that you do. Thank you for coming in today to We Talk Health.

SPEAKER_00 28:39

Thank you.

SPEAKER_01 28:39

Thank you very much for having us, and I'm gonna send that shout out that you just gave to all of our colleagues too, because it's just an amazing job uh around what says healthcare. So if any of them are listening, thank I thank them for everything that they do every day, taking care of these patients. Join you in that too.

SPEAKER_02 28:56

This is uh this has been We Talk Health.