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Saturday, March 25, 2023  

Denver VA’s virtual ICU streamlines care in rural areasPublished 10/12/2010

by Joelle Moran Staff Writer

The Denver VA Medical Center launched its virtual ICU (vICU) a year ago with the goal of increasing access to critical care in rural areas.
The program--the first in the entire VA system--has exceeded expectations for Carrie Hawkins, the vICU coordinator and assistant nurse manager of critical care at the Denver VA. The program has been a tremendous success in more ways than one, from improving care for veterans to advancing nurses’ practice and unifying the VA’s Western Region, which includes Wyoming, Colorado, Montana and Utah.
“It was a huge initiative to get this going,” said Hawkins, RN, BSN, CCRN. “We’re all very pleasantly surprised at how well it went and the things we’ve accomplished.”
In its first year, the Denver vICU has had more than 500 encounters with the VA’s four Western rural sites in Grand Junction; Cheyenne, Wyo.; Sheridan, Wyo.; and Helena, Mont. VA Medical Centers in Denver and Salt Lake City serve as tertiary sites. Through those encounters, the vICU nursing team initiated 100 interventions with nurse-to-nurse or physician-to-physician collaborations and expedition of transfers.
Traditionally, vICUs operate with physicians who monitor patients remotely by telemetry 24/7. But the Denver VA’s vICU is unique in that it is a nurse-driven rapid response and consultation service, which maintains the autonomy of the nursing staff.
“We are all about being proactive and giving nurses tools that enhance care of their patients at their home sites, because a lot of times they don’t have access to knowledge of critical care techniques so patients are transported,” Hawkins said.
With a staff of 18 nurses who are all Critical Care Registered Nurses (CCRNs), the vICU provides an around-the-clock nurse hotline for immediate critical care consultation, collaboration and support.
Nurses at rural sites are encouraged to call the hotline, day or night, if they have a question about a procedure, treatment, diagnosis or medication. Physicians may also have nurses call to initiate subspecialty consults if they need to transfer someone to Denver and help secure a bed immediately, Hawkins said.
“We do all the legwork. We find out what’s going on and present it to specialists and then they call,” Hawkins said. “It speeds things up. The physicians really love it.”
Launching the vICU has been a yearlong process with several phases under Hawkins’ direction. After launching the hotline, a sophisticated telehealth video-conferencing system was launched.
Every Western Region VA site has a mobile video-conferencing cart that is used for virtual consults with nurses and physicians in Denver’s vICU. For example, a physician in Denver can hear the breath sounds and heartbeats of a patient in Helena, Mont., via stethoscopes and exam cameras from the cart.
One of the benefits of the virtual consultations is that patients can be stabilized at rural sites, avoiding transfers to the Denver VA. On the other hand, the vICU is able to assist in securing beds for patients that need to be transferred, resulting in quicker turnaround and increased customer satisfaction.
     “We are streamlining the process for them,” Hawkins said. “Physicians and nurses are able to call the vICU for consults directly instead of waiting several days, so patients are getting what they need quicker and not having to be transferred as much, and if they are, they’re getting to the sites quicker. There are no interruptions in care.”
The next phase of the vICU is the addition of clinical information systems at each of the ICUs in the Western Region. Once up and running, a vICU nurse will be able to access an electronic flowsheet for any patient in the region.
Another aspect of the vICU is its virtual rounding with physicians in Cheyenne. Typically a patient in Cheyenne who needs a complex surgery is transferred to Denver, and his physician comes with him, performs the operation and stays in Denver. Now with the video-conferencing equipment, the physician can do virtual rounds on the patient after returning to Cheyenne. As soon as the patient is stable, he is transferred back to Cheyenne.
“He has the same doctors the entire time. The vICU nurses talk to the nurses in Cheyenne and it’s a real seamless process,” Hawkins said.  “We’ve done it four times so far and it’s worked great. The patients love it. They’re still able to talk to their doctors who they’ve known forever. It’s an extra sense of security.”
As with any major undertaking, launching the vICU came with challenges. At first, Hawkins said nurses at the rural facilities were skeptical of the program.
“There was the whole Big Brother aspect and the facilities were very weary of what this was going to be,” she said. “Nurses at smaller facilities were afraid it would turn into Big Brother watching them.
That is absolutely not the case. We’re helping out colleagues and giving them the tools that they need to get the job done.”
Hawkins spent much of the past year traveling to the rural facilities, meeting with nurses, managers, internists and administrators to answer questions and explain how the vICU would benefit the rural sites and veterans.
“We were really selling them on the program, letting them know that this program really is for them--an extra layer of support if needed,” she said.
Launching such a groundbreaking initiative was extremely challenging and exciting, Hawkins said, and she enjoyed visiting all of the Western facilities, getting to know the nurses and managers and building relationships region-wide.
“We’re unifying and that has been really nice to see and very satisfying as well,” she said.
The idea for launching the vICU in the Western Region came out of the rural health initiative of Dr. Leigh Anderson, chief medical officer of the VA’s Rocky Mountain Network. The region is the largest in the VA system and its patients live in highly rural areas, making access to care very difficult, Hawkins said.
Another unintended benefit of the vICU has been the surge it has created for nurses seeking CCRN certification. To work in the vICU, a nurse must be a CCRN, which requires meeting specific in-depth competencies every year. Since the vICU started, there has been a 50 percent increase in CCRN-certified nurses in the past year.
“The nurses like it so much and this extra level of responsibility that everyone wants to be an vICU nurse,” Hawkins said.
“If you are a CCRN, you are the cream of the crop of ICU nurses, especially with this program,” she said. “They have to not only be an amazing nurse, they’ve got to be able to manage the technology.”
Hawkins has worked at the Denver VA for five years. She worked in surgical ICU and became assistant to Critical Care Nurse Manager Vickie Custer in 2007, and in 2009 took on the role of Vicu coordinator.
   “Vickie is such a a great boss and mentor. I’m very lucky to work with her,” Hawkins said.
Nursing is a second career for Hawkins, who graduated with an English degree from the University of Colorado-Boulder in 1997. She was working for the Environmental Protection Agency in Washington,
D.C., and then answered her call to nursing. She returned to Denver and earned her BSN from Regis University in 2004. She is pursuing her masters degree at Regis in Leadership and Health Care Systems with a management focus.
She did one of her senior practicums at the Denver VA’s ICU and fell in love with the veterans.
“They are so appreciative of your care. They are so wonderful,”
Hawkins said. “Every time I come to work, I say, ‘I’m so glad I work here.’ It’s so true.
“You spend one day here, and you’re just in love with all of them.”

Denver VA Medical Center staff from left MD Frank Wright and RN Amy Dzur demonstrate the telehealth video-conferencing cart on a mock patient as RN Terry Breen and MD Thomas Robinson consult virtually on the video. An X-ray of the patient’s lungs are on one side of the screen and the nurse is placing a virtual stethoscope on the patient’s chest so the nurse and physician can hear and access her breath sounds remotely.
Denver VA Medical Center staff from left MD Frank Wright and RN Amy Dzur demonstrate the telehealth video-conferencing cart on a mock patient as RN Terry Breen and MD Thomas Robinson consult virtually on the video. An X-ray of the patient’s lungs are on one side of the screen and the nurse is placing a virtual stethoscope on the patient’s chest so the nurse and physician can hear and access her breath sounds remotely.
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