1) Telenursing in the Intensive Care Unit (ICU) involves using telecommunication technologies to remotely monitor critically ill patients and support bedside healthcare teams. 2) The number of patients requiring critical care is increasing due to an aging population and advanced treatments, yet resources are decreasing. Tele-ICU aims to address these challenges by providing remote monitoring and expertise from ICU specialists. 3) Studies have found tele-ICU can reduce ICU and hospital length of stays and mortality while increasing compliance with best practices. Tele-ICU nurses monitor patients, collaborate with bedside staff, and ensure best practices are followed to increase patient safety.

1. Telenursing in the Intensive Care Unit
Chief Nursing Officer, OUH
Merja Meriläinen, RN, PhD
merja.merilainen@ppshp.fi

2. Northern Ostrobothnia Hospital
District
• OYS, Oulaskangas and Visala
• Kehitysvammahuollon palvelut
• NOHD: c. 400 000 inhabitants
• NOHD ERVA: c. 740 000
inhabitants
• Embloyees c. 6600
• Beds: 985
• Patient days 260 000
• Budget 555 m€

3. Daily challenge in healthcare
Rapidly changing
healthcare
Decreasing
resources
Healthcare
innovations
Patients and
families
expectations

4. Current and future challenges in
ICU
•Number of patients needing critical care are increasing
–Ageing population and increasing life expectancy
–Increasing healthcare expectations
–Advancing cancer treatment, transplantation and high risk surgery for the elderly
population
–Pandemics
•Financial burden and decreasing ability to pay
–Skilled specialists for decision making to target the critical care resources to
those most likely to benefit and to achieve best outcomes
•Increasing need for critical care services faces decreasing physician and nursing workforce
–Critical care patients need specialized care takers with high competence level
–Critical care is a human resource intensive therapy (P/N 1:1)
–Already today limited intensivist coverage in smaller hospitals and rural regions
•Critical care services are increasingly needed outside the ICU walls
–Patients with critical illness may be found throughout the hospitals
–Need for remote monitoring techniques to identify those at risk earlier
(Ala-Kokko T. THALEA Round table meeting 30.10.2014 OUH)

5. Tele-ICU
• Is the arena where informatics and
telecommunication technology, coupled with
telemedicine and telenursing, are bought
together to affect the care of critically ill
patients
• It provides expert-driven, evidence-based,
cutting-edge services for the monitoring and
treatment of critically ill patients
• It supports the bedside health care team through
collaborations between the tele-ICU nurse and
the bedside team
(www.americantelemed.org., Stafford et al. Working in an eICU unit: Life
in the box. Crit Care Nurs Clin 2008; 20.)

6. Outcomes
• Reductions in ICU mortality
• Shorter stays in the ICU and the hospital
• Increased compliance with evidence-based
best practice (e.g. screening for sepsis)
• Experienced ICU nurses and intensivist
physicians help to monitor and treat
critically ill patients and provide an
additional layer of safety
• Decreased cost of patient care
(Kohl et al. 2007, Zwada et al. 2009, Dickhaus et.al. 2006, King et al. )

7. The role of the tele-ICU nurse
• Make rounds via camera and patient
database
• Assess patients via database
– Verification of continuous infusions
– Follow-up of laboratory values
• Video assessment of patients´ physical
appearance
• Equipment safety check
• Verbal interactions with patients, their
families and bedside staff

8. • Acts as a resource for the bedside nurses
(second set of eyes and ears)
• Ensures that best practice is adhered to
• Responds to questions and requests from
bedside staff
• Teleintensivist and telenurses can educate
bedside novice physicians and nurses by
walking them through unfamiliar procedures
(Williams et al. 2012, Reis M 2009)

9. Tele-ICU nursing interventions
• Williams et al. 2012
– N=594
– 477 (80%) independent nursing interventions
• Assistance
• Brainstorming
• Overall collaboration
• Rescue interventions
• Prevention
 Increased patient safety

10. Tele-ICU nursing: what is it not?
• It does not replace bedside nursing or the
bedside team
• It does not replace direct patient contact
• It is not a way of decreasing staff
numbers

11. What hopes do we have for
telenursing?
• Online, real time communication
between ICU experts
• Shared knowledge
• Expert-driven, evidence-based treatment
for critically ill patients

12. What does tele-ICU nursing
require?
• Clarity in roles between bedside team and
tele nursing team
• Functional and easy-to-use system
• Monitor view that provides an easy-to-
understand holistic picture of a patient’s
situation
• Interoperable, a user friendly and intelligent
global decision supporting system that can
be customized for local needs

13. What next?
• More interactive?
• Higher speed?
• More intelligent solutions?
• Extra staff?
• Do we really understand what we could
request from these solutions?
• Can we move from crisis management and
problem-solving to real innovations?

14. THALEA®
European Demand of a ...
• Telemonitoring and Telemedicine System for the
demand of
• Hospitals need in Early Warning and Detection of
Severe Infections
• Assisted by innovative ICT (effective management)
for
• Life saving co-morbid patients in
• Europe
• As part of a Patient personalised care programme of
the EU

15. The 8 THALEA partners:
1. University Hospital Aachen (coordination) (Germany)
2. German Ministry of Innovation, Science and Research
(Germany)
3. Maastricht University Medical Centre+ (Netherlands)
4. NL, Agency, Ministry of Economic Affairs
(Netherlands)
5. ParcTauli Sabadell University Hospital (Spain)
6. Catalan Agency for Health Information, Assessment
and Quality (Spain)
7. Hospital East Limburg (Belgium)
8. Northern Ostrobothnia Hospital District (Finland)

16. THALEA®
• THALEA enables Intensive Care Units to
improve the care for acutely live-threatened
patients by telemedicine and telemonitoring
• Within the Thalea project, an ICU
telemedicine system is developed using pre-
commercial procurement(PCP); an
oppertunity to develop new solutions and to
introduce new technologies and products in
cooperation between suppliers and hospitals

17. • The THALEA Project aims to follow ICU
patients in various hospitals from a
central 'cockpit' location
• In this cockpit, a team of ICU experts will
continuously monitor different values,
such as blood pressure, insulin levels,
dehydration, medication and dozens of
other indicators, procedures and
guidelines

18. • Tender process, which involves extensive
research on the actual procurement
expected in the future, consists of three
phases:
– preparing the public tender
– a pre-commercial procurement phase
– a public European tender that should
ultimately lead to the marketability of
concrete software products

19. PCP process
Supplier B
Supplier C
Supplier D
Phase 1
Solution design
Phase 2
Prototype
development
Phase 3
Original development
of limited volume
of first test products /
servicesSupplier A
Supplier B
Supplier C
Supplier D
Supplier B
R&D / Pre-commercial Procurement (PCP)
Phase 4
Deployment of commercial
end-products
Diffusion of newly developed
products / services
Supplier D
Supplier(s)
A,B,C,D
and/or X
European Commission: COM (2007)799

20. More information
• http://www.thalea-pcp.eu/
• OUH/Thalea team:
– Project Manager Timo Alalääkkölä,
timo.alalaakkola@ppshp.fi
– Professor Tero Ala-Kokko,
tero.ala-kokko@ppshp.fi
– Chief Nursing Officer Merja Meriläinen,
merja.merilainen@ppshp.fi
– Intensivist Janne Liisanantti,
janne.liisanantti@ppshp.fi

21. Thank you!