As reported by National Geographic: 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.
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.
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.
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."
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