Why you should care
Because Nebraska Medicine might change your doctor’s bedside manner forever.
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Before they set a toe into the concrete-walled isolation room, the doctors and nurses become fortresses unto themselves: face shields, of course, but respirators, too, plus three layers of gloves on each hand, duct-taped to their sleeves. Nurses watch over a webcam to keep them on protocol, and Bluetooth stethoscopes relay heart data directly to a remote location — no ear canal exposure required.
Call it the no-touch approach to medicine. And it’s the little-heralded reason that a hospital in Nebraska, of all places, has emerged as a leader in the stateside fight against Ebola. Already, it’s brought two Ebola patients to recovery and prevented transmission to health care providers. The Centers for Disease Control and Prevention has held up the hospital as a model for others.
The challenge is to harness technology’s protective power without jettisoning the bedside manner, a key to healing.
All around the world, of course, the health care workers who’ve been treating the terrifying disease avoid skin-to-skin contact with patients and use a battery of protective equipment, like gloves and air-filtering PAPR suits. But Nebraska Medicine, near downtown Omaha, has taken protection to a whole new frontier — and into the slightly eerie field of hands-free medicine. If successful, the approach could have implications for medical practice, even beyond Ebola, especially as the burgeoning field of telehealth takes off. (The U.S. telehealth market could grow more than 50 percent annually through 2018, Forbes reports.)
The challenge is to harness technology’s protective power without jettisoning the bedside manner, a key to healing, Nebraska health care practitioners acknowledge. They’re navigating the trade-offs with computer screens that display “almost life-size” images, said Nebraska Medicine lead nurse Kathleen Boulter. And although providers remain hidden beneath layers of latex and paper, their patients have surprised them with an ability to recognize them by their eyes. “A lot of emotion is expressed by our eyes,” she said.
And so far, the hospital has a 100 percent success rate on Ebola. Its first Ebola patient, 51-year-old missionary Dr. Rick Sacra, stayed for nearly three weeks before his release. On Oct. 22, the hospital discharged its second patient, NBC freelance cameraman Ashoka Mukpo, 33, after a roughly two-week stay, said Boulter.
So how does Nebraska Medicine work? It starts with a secured entrance. To limit traffic in and out of the isolation room — and the risk of spreading disease — it uses the Vidyo videoconferencing platform. The isolation room houses a webcam-equipped computer connected to the front desk, the biocontainment unit’s conference rooms and providers’ offices outside the unit. And inside the isolation room, providers can request a second opinion or order supplies without ever leaving. “If something’s going on, we know right away,” Boulter said.
Providers can request a second opinion or order supplies — without ever leaving the isolation room.
Traditional stethoscopes also pose a huge contamination risk, medical professionals say, because they require practitioners to lodge earpieces into their ear canals. Tech, of course, has found a way around this. The 3M Littmann Electronic Stethoscope looks much like a regular stethoscope, but its Bluetooth capabilities allow Nebraska Medicine providers to take their ears out of the equation. Instead, a sensor goes onto the patient’s chest. A USB dongle, connected to the computer in the isolation room, establishes a Bluetooth connection with a remote computer. Providers outside can listen to a patient’s heart and lung sounds in real time. They can even tell health care workers inside the isolation room to reposition the sensor.
Another stethoscope used by Nebraska Medicine is the Thinklabs One Digital Stethoscope. Its high sound quality allows health care workers to wear earpieces over their surgical caps, eliminating ear-canal exposure. They slip them on just before entering the isolation room and plug them into a hockey puck-sized sensor — equipped with a volume-control module — that picks up sounds from the patient’s chest. Providers chuck the earpieces into the hazardous waste bin when they doff their protective gear.
Meanwhile, devices that monitor pulse and other vital signs upload measurements to the patient’s electronic health record. And a wireless-capable X-ray allows nurses to send images directly to radiologists, skipping the step of transporting bulky film cassettes to the medical imaging department for processing.
A wireless-capable X-ray allows nurses to send images directly to radiologists.
Behind the no-touch push is Nebraska Medicine’s information technology department, which is “robust across all units, not just biocontainment,” Boulter said. “Even on regular floors, nurses have laptops on them” and rely on the same wireless X-rays. And the Center for Medicare & Medicaid Innovation awarded the hospital a $10 million telehealth grant in July.
And while other hospitals have embraced telehealth too, practitioners hope the healing touch is here to stay. “There are times when something as simple as holding a patient or family member’s hand conveys calmness, caring, reduces fear. … I don’t believe the effect of a human touch is something that can be replaced,” Boulter said.
Even the hospital’s telehealth guru, Kyle Hall, agrees: “[I]t’s still about a human diagnosing the patient.”