October 29, 2018

Priya Toussaint recalls a particularly stressful moment in her early days as a nurse in the pediatric intensive care unit, which can be an intimidating and isolating place to work: “I remember feeling really overwhelmed while managing a patient receiving three IV antibiotics and trying to fit them all in within a certain time window. Then I asked Dawn for help checking the meds and she made it easier to take care of the patient.”

However, Dawn Della Noce, the veteran pediatric ICU nurse Toussaint referred to, was not in the same room. She was out of sight. As the base nurse for a novel telemedicine project in the unit, she was down the hall in a room lined with monitors that virtually connected her with nurses such as Toussaint who were staffing the 44-bed ICU. Her role? To act as an additional experienced set of eyes and ears for the nurses, especially those new to the unit.

“I was excited to be a resource for nurses like Priya,” says Della Noce, who has worked in the ICU at Johns Hopkins Children’s Center for 24 years. “I have virtual eyes in each room—I can zoom in and see all of our patients, check their bedside monitors, assess them with the nurse in the room.”

The initiative, launched in 2017, is in part a response to both the rising complexity of ICU patients and increasing turnover on intensive care units, reflecting a national trend.

“We are entering into a nursing shortage, with the typical workforce length of employment at three to five years,” explains Dawn Luzetsky, director of pediatric nursing. “This may be our new norm.”

Under the tele-ICU model, the staff aims to fill that gap and at the same time improve patient safety and quality of care. Luzetsky notes that the base coaches, acting as mentors and coaches as well as experienced resources, have helped enhance novice nurses’ critical care knowledge and clinical skills. Consequently, the unit has experienced improved patient adherence to high-risk medications and fewer central line-associated bloodstream infections (CLABSI).

“The evidence shows that nurses feel more support at the bedside and that we can sustain and improve quality practice outcomes for CLABSI,” says Luzetsky.

“They know they’re not going to be chastised for any questions they have,” adds Della Noce. “I feel like it’s made a great difference.”

Toussaint agrees: “I love the idea of it, the additional support that allows me to follow through with my care of the patient. If I have to check medications or run to the pharmacy, I can call the base nurse and ask her to keep an eye on my patient, which gives me peace of mind knowing someone is always watching.”