"To better connect patients in the ER to caregivers in the telehealth realm who would eventually be overseeing their care in the intensive care unit at those sites … so it helps make that transition earlier and helps to create a layer of back-up and extra monitoring to make sure we're meeting all the sepsis care goals," Dr. Bond explains.

Cooley says the monitoring included cameras on the telehealth cart, patient vitals as seen on in-room monitors, conversations between the ED staff and eICU nurses via telephone, or a combination of the three.


Patients can benefit from another set of eyes, according to Cooley.

"They can monitor the patient's vitals. They can have their eyes on the patient and can see them start to just kind of get confused and then they (eICU critical care nurses) can alert the nurse in the next room, 'I'm concerned about your patient in the next room, can you go in and check on them?'"

Simulation can instill confidence in adopting new technology and that happened in this case. Using survey tools and teleconferencing software, the researchers were able to measure the impact of the on-site simulation, which boosted confidence in the use of telehealth. Cooley said through simulation, doctors, nurses and other caregivers learned how to communicate with patients and their families about the new tools – another plus.

"During the simulation, they were able to practice introducing that telehealth cart to the patient so that takes some of the stress and awkwardness away if you can practice in a somewhat lifelike situation but you're not practicing on a patient the first time."

The simulations used a trained actor, also known as a standard participant, who indicated during debriefing sessions that in a real life situation, most patients and their families would find it comforting to know a remote eICU nurse was also keeping an eye on them. The three-act simulation used scenarios in which the patient continued to decline, followed by staged debriefings.

Results are still being evaluated, including the reluctance by some care team members to use the technology as it is currently set-up. These barriers can likely be overcome by improved telehealth integration, reducing or eliminating the need for a separate cart.

Bond says the research did confirm the value of the simulation and how it can be helpful for future telehealth integrations by OSF HealthCare or other health systems. The sepsis simulation toolkit is available on the Jump Simulation and Education website. The Jump Center and its resources can be used by other health systems which want to trial telehealth solutions through simulation.

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