It's 3 a.m. Do you know where your night-shift ICU doctors and nurses are?
For Atlanta's Emory Healthcare, the answer to that question is Sydney, Australia.
Like all health systems, Emory is dealing with staffing issues caused by the physician shortage. Of particular concern was finding experienced people to work in the intensive care unit during the “unsocial" hours of nights, weekends and holidays.
An Emory electronic ICU center was launched in March 2013 that provided remote audiovisual monitoring to the archipelago of Emory hospitals located several miles apart. Located on the campus of Emory St. Joseph’s Hospital, the center serves the ESJH ICU plus those at four other Emory institutions and provides an experienced “pair of eyes” to lend support to bedside caregivers.
Even with this innovation, however, off-hour staffing was tough, and it took a toll on the health of night-shift workers. But Emory came up with a novel way to address these concerns.
“We wanted to improve the work-life balance and literally turn night into day,” says Timothy Buchman, M.D., Emory’s chief of critical care service. And so was launched a six-month study of the effect of shifting operations to the other side of the globe. The study is not testing the impact on patients’ well-being, but rather the well-being of doctors and nurses who provide night-shift service in daylight hours.
“If we could improve the work-life balance of providers, could it improve their health and the care they deliver?” Buchman asks.
The initiative was launched in mid-July and goes until mid-February with a few weeks off for the holidays. An Emory nurse and doctor relocate for six to nine weeks and use technology from the Royal Philips company to monitor patients in Georgia while working from MQ Health facilities located at Macquarie University in Sydney.
The heart rates of Emory caregivers in Australia are being monitored to identify any signs of stress and sleepiness, Buchman says.
“There’s no end to the good that can be done,” says Cheryl Hiddleson, R.N., director of the Emory eICU Center. She contrasted what Emory is doing by using its own staff with other operations that use remote radiologists or intensivists for hire.
“They hire a doctor from anywhere to sit in front of a computer,” she says. “They’re outsourcing a single task. They don’t look at patients or interact with bedside staff.”
Current telemedicine policies call for providers who deliver telemedicine services to be licensed in the state in which the patient is located. This is not an issue since all the Emory providers already have licenses to practice in Georgia and are credentialed by Emory hospitals, Buchman says. Conversely, none of the Emory physicians provide care to Australian patients while they are in Sydney.
That said, Hiddleson believes there are invaluable opportunities to share real-time knowledge and learn from different health care cultures. Buchman adds that Macquarie University provides an ideal setting for such an international exchange.
“This is the wonderful thing — we’re in the same building as the Australian Institute of Health Innovation,” Buchman says. “We meet down in the coffee line and you get the ‘What if?’ conversations that lead to new collaborations, new research and new insights.”
Also, Hiddleson reports that the potential language barrier between Australian and Georgian accents “has not been an issue,” though Buchman says that he had to learn how to order coffee and that his regular order now is a “long black.”