Tom McMahon , Staff writer

Originally published 02/11/2008

Dr. Louis Violi sits at one of five eFocus stations. Three critical care nurses and a health care assistant sit at the others. Each is surveying six computer screens holding vital health information on Alegent's five metro-area hospital's sickest patients. One nurse flips a switch that pulls up an Alegent Health Mercy Hospital patient's room. The patient is in bed. The nurse activates the audio system, asking the patient how she is doing. The patient answers in a joking way. The nurse, located at the eFocus control room in west Omaha, laughs.

Violi checks a red warning flag on one screen. It indicates a Bergan Mercy Medical Center patient's oxygen level is low. This patient has a condition that results in a constant low level, he notes. No need for concern here.

Alegent began operating the high-tech system with Immanuel Medical Center's intensive care patients July 20 of last year. Mercy's 18 intensive care beds were added Jan. 31. Overall, eFocus staff members keep tabs on 86 beds at Mercy, Bergan Mercy, Immanuel, Midlands and Lakeside hospitals. Alegent plans to expand the service to its Missouri Valley, Corning and Schuyler, Neb., hospitals within the next six months.

"It provides us the capability to monitor patient condition changes and make timely, acute interventions," said Violi, a critical care physician also known as an interventionist. He said eFocus augments in-hospital care. Critical care nurses and on-call physicians still monitor and provide bedside hands-on care, Violi said. At least one physician is at the eFocus center at all times and can write orders and make instantaneous care changes when needed, he said.

Prior to this system, Violi said he would travel between hospitals, seeing patients and consulting with staff. Now he's just a push-button away.

"There are not enough critical care specialists today," Violi said. "More are retiring, and we have more older patients." Through eFocus, it is possible to monitor more patients and observe trends that could indicate a problem is developing. Earlier intervention could save lives, Violi said.

Kim Sieck, R.N., is eFocus' operations director. She compares her staff to a football coach sitting in the press box during a game.

"The other coaches and team are on the sidelines. We can see the field from a different vantage point and relay information to them that could help."

Sieck said Alegent's hospitals continue to provide one nurse for every two intensive care unit patients within the hospital setting. She said eFocus allows those nurses more time at patients' bedsides providing hands-on care. Meanwhile, her staff of experienced ICU nurses and doctors monitor and assess patient progress and support their efforts via instant back-and-forth visual and audio communications. Sieck said each nurse can monitor up to 30 patients at one time. Nighttime tends to be busiest.

"During the day, you tend to have a lot more resources at the patient's bedside," Sieck said. "After 5, it can get pretty hectic in here." Physicians are moving between stations at a fairly steady clip, and communications with onsite hospital staff is brisk. Sieck said recently a physician wrote 100 different orders during his overnight shift.

She said a side benefit of the new system is allowing some nurses to extend their careers. Sieck said one staff member with 37 years of ICU experience was getting ready to retire after undergoing a hip replacement.

"She couldn't be on her feet all the time," Sieck said. But sitting behind a desk monitoring computer data takes no toll on that part of the nurse's body.

"Nurses at the hospital say their feet hurt when they get off work," Sieck said. "When they leave here, they say their head hurts."

Republished with permission from the Daily Nonpareil.