Turning “Night into Day”: Challenges, Strategies, and Effectiveness of Re-engineering the Workflow to Enable Continuous Electronic Intensive Care Unit Collaboration Between Australia and U.S.

Abstract

Safe and effective care of critically ill patients requires a team of professionals including specialty physicians (intensivists) and critical care nurses experienced in providing care for patients in the intensive care unit (ICU). While critical illness can strike at any time and demands continuous attention, allocation of scarce staff follows a predictable pattern. The night shift is more likely to have disproportionately newer and thus less experienced nurses, and the experienced nurses on that shift are engaged in providing care to their own set of patients (Claffey 2006; Floyd 2003). At times this leaves them unable to sufficiently supervise the newer staff. There is also evidence of increased risks at night time with higher in-hospital mortality for admissions at night (Coiera et al. 2014).

Emory Healthcare developed a program to provide support for staff working at the bedside in the intensive care units (ICUs) across their system. Implementation of a tele ICU program has allowed 24/7 access to physicians trained in critical care (intensivists) and experienced critical care nurses in that area of practice for the teams in those ICUs. The Emory eICU Center began with a goal of achieving the triple aim of better health, better experience of care and reduction of cost, and has shown positive outcomes for patients (Trombley et al. 2017). The newly added fourth aim of increasing joy in work for clinicians became the next focus of the program. Night time work has been an area of dissatisfaction for Emory clinicians so a plan to address that concern was created. Emory relocated their tele ICU clinicians to a location antipodal to Atlant, thus allowing them to do their night time work during the day time hours in the new location.