eICU

Discussion in 'Critical Care' started by codeb1ue, Apr 1, 2017.

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  1. codeb1ue

    codeb1ue ASA Member 7+ Year Member

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    Nov 13, 2008
    Seattle
    Do any of you have experience working in an eICU? I saw an opening for a position for one in my area but don't know exactly what it entails. How different is it from the standard in-facility shifts? Thanks in advance.


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  3. G-Man82

    G-Man82 10+ Year Member

    376
    157
    May 16, 2005
    The Southeast
    Physician
    I'm actually in an eICU now. The model we use is one where physicians are present on nights, weekends, and holidays and it's pure shift work, which is nice. But I'm credentialed at all the sites, which can be a pain, and I have access to all the EMRs and can place orders. The camera system is powerful enough that when zoomed in I can read the ingredients off an IVF bag.

    The system works well when there are residents or affiliate providers at the bedside so that at least someone can place lines and do quick bedside procedures. I'll tell you this though, it definitely gives you insight into community practice and at times, it's horrifying what people get away with.


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  4. codeb1ue

    codeb1ue ASA Member 7+ Year Member

    153
    15
    Nov 13, 2008
    Seattle
    Thanks for the response. If you don't mind, I have a few follow up questions.

    What is your day to day shift like? Are you just staring at telemetry monitors? Are you "rounding" by looking at every patient and reviewing all the data and calling consults from afar if needed? Or are you just hanging out browsing the web and answering pages/calls as needed regarding urgent situations. Also what do you do when there isnt an affiliate provider? How do you handle crashing patients and stuff.
     
  5. G-Man82

    G-Man82 10+ Year Member

    376
    157
    May 16, 2005
    The Southeast
    Physician
    Depends on the model. For us, we can be either very active or just there to put out fires. In general though:

    Day to Day. We're 12-hour shifts. Receive sign-outs from the attendings at most of the hospitals and then get to work. We are required to "see" new patients, though that doesn't always mean I write a note. If things go wrong in one unit, they'll hit the button and I'll pop up on screen. If it's a code, I'll help direct it. For new admits, if I need a consult I'll call. My eICU RNs will also help by monitoring. They are the ones who often triage for me and also stare at the telemetry monitors.

    Usually, though, I see myself as someone to put out some of the night-time fires that occur and I serve as a resource for some of the residents on duty overnight and for any affiliate providers. In hospitalist-run ICUs, I serve as their CCM consult at night. You'd be shocked at what happens in some of those units that would normally be second nature to us.

    There is often down-time for browsing the web. Sometimes there's something happening somewhere and you're kept busy. But at the end of the shift? You sign off and leave. Done.

    Some units just have RNs. Those are frustrating but also somewhat rewarding. For things like line placements and intubation, you (or the RN) will call either the ED/Anesthesia etc. Often, you see a different standard of care that is appalling ... just realize that they work at a different level than you're probably used to. At the same time you really change the course of some of those patients.

    Hope this helps. A lot of it is MICU based but we cover a bunch of CVICU in the eICU system as well. I'm an Anesthesiologist, but seem to handle the MICU stuff without trouble.


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    Last edited: Apr 4, 2017
  6. lilzelda2

    lilzelda2 7+ Year Member

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    Aug 20, 2007
    How does malpractice work in the eICU, especially in regards to procedures. Would you recommend it to people who are interested and what are some the negatives with it as a practitioner?
     
  7. G-Man82

    G-Man82 10+ Year Member

    376
    157
    May 16, 2005
    The Southeast
    Physician
    I essentially order procedures or the APPs do them on their license and send the note to the Attending on service, not me. So I doubt there's any liability on my end, especially since I'm sometimes 200 miles away. As far as liability otherwise, I'm really not sure. If anyone has a better answer I'd love to know too.

    For the most part, I'm a consulting attending because I literally cannot touch the patient. My assumption is liability is limited to what I can and cannot do. If I make a bad call, then sure. But if I'm there putting out fires, then who knows?


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  8. Physio Doc 2 Be

    Physio Doc 2 Be Supratentorial problems 7+ Year Member

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    Sep 4, 2007
    TDC
    Physician
    I wondered about this. Four of the places I interviewed were hawking eICU as a strength, but I wondered how that works with a crashing patient who needs procedures. Are you on the hook if the midlevel can't do them? What other liability do you assume in that role?
     
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  9. G-Man82

    G-Man82 10+ Year Member

    376
    157
    May 16, 2005
    The Southeast
    Physician
    You can always have them consult out for the procedures. Or if it's a place where midlevels don't exist, then usually you call surgery, EM, or Anesthesiology depending on the hospital. One of the places I staff via eICU, I call Anesthesiology. They cover L&D at night and so are in-house. If nothing is happening, then they usually come by. Same thing with the hospitalists. At another place, surgery is on the hook for overnight lines. Some places have the ED Attending do them.


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  10. FFP

    FFP Grunt/cog/body Gold Donor 7+ Year Member

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    Oct 17, 2007
    Very curious about liability with eICU myself. It's like supervising anesthesia cases remotely while relying on somebody else's non-handpicked CRNAs.
     
  11. EMIM2011

    EMIM2011 5+ Year Member

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    Feb 14, 2011
    Does anyone know what the typical compensation is?

    And how about documentation? Do you write essentially a consult note on every new patient that is admitted during your tele shift?


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  12. G-Man82

    G-Man82 10+ Year Member

    376
    157
    May 16, 2005
    The Southeast
    Physician
    Not sure what typical compensation is for outside eICUs. Where I am, a voluntary shift actually pays more than an OR shift with, in my opinion, a lot less work and many fewer layers of BS politics.

    Documentation really is minimal, at least where I am. A few lines really. We're not writing consult notes. We're an extra layer of care. But then again, what needs to be in a critical care note? 1. The patient is critically ill. 2. CC minutes non-overlapping. 3. Conditions you managed. We don't need to wax on about the way the dude presented or list 14 differentials. Where I am, we are to "see" the new admits and put in a brief note at some point. Also realize that many third party payors don't reimburse eICU, so the money has to come from somewhere.


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