North Hawaii’s hospital has gone high-tech with intensive care.
North Hawaii’s hospital has gone high-tech with intensive care.
North Hawaii Community Hospital undertook an unpublicized soft opening of its new telemedicine ICU for a few weeks before making its public announcement. The telemedicine ICU uses two-way video to let physicians specialized in intensive care examine North Hawaii ICU patients from The Queen’s Medical Center in Honolulu.
North Hawaii hospitalists specialized in treating hospitalized patients do rounds alongside ICU nurses and, virtually, Queen’s intensivists.
Now that the service has become routine, hospital officials went public, emphasizing the increased level of care, potential for patients to remain close to home and for better patient outcomes — because transfers to Oahu, when needed, might happen faster.
Intensivists, specialists in critical care, can do head-to-toe assessments of patients in Waimea, said North Hawaii Community Hospital ICU Nurse Manager Nadine Reese.
Reese said patient rounds in the Waimea ICU happen twice daily, with NHCH hospitalists, Queen’s intensivists, NHCH ICU nurses, patient family members and, if able, patients themselves all participating in a shared check of current status. NHCH can consult with Oahu specialists 24/7.
The four-bed Waimea ICU is slow enough in patient volume that is can’t support a full-time specialist in intensive care.
“We don’t come cheap and we need to be busy to actually pay our way,” said Dr. Scott Gallacher, a pulmonary and critical care physician and medical director of The Queen’s ICU.
But the few patients in Waimea’s ICU need specialists as much as patients on Oahu. Oversight from specialists helps potential problems such as sepsis get caught quickly.
“It’s different, in that you cannot actually physically touch the patient,” Gallacher said. But, he added, “we can see pretty much everything we could see in person.”
Technology can bring X-rays and visual inspection directly to the specialist’s eyes on Oahu.
“I think people need to be reassured, and part of that reassurance might be, maybe, a hand on the shoulder,” Gallacher said. Tone of voice and spending more time interacting with the patient can help counter the physical separation.
“A lot of what happens in the ICU is time-dependent,” Gallacher said. That’s why a specialist’s eyes are important.
Gallacher said the team effort, doing patient rounds with the ICU nurses and hospitalists in North Hawaii, helps catch problems earlier and prevent potential crises.
Reese said NHCH is “very rural” and daily access to specialists allows consults to which most rural hospitals don’t have access.
“It just opens us up to a whole other avenue,” she said.
Despite its rural location, the North Hawaii ICU sees a wide variety of patients, including tourists who were on a long flight and develop a blood clot, people with pneumonia or influenza and people involved in water accidents, car accidents, work injuries or falls.
“Families are fully involved and able to ask questions,” Reese said. “It is very reassuring to the families.”
Patients who need to be transferred, or their family members, “are already talking to that physician that they’re going to meet.” That decreases stress.
This is phase I. Phase II, set to be rolled out in early 2018, will include live heart rhythm, respiratory rate and blood pressure feeds to specialists on Oahu.
Telemedicine has been well-received in the Waimea ICU, Reese said.
“Some of our first patients were really excited to do it,” she said. “A couple of people combed their hair and put on their makeup.”
Email Jeff Hansel at jhansel@hawaiitribune-herald.com.