Intensive Care, No Matter Where

Flexible “virtual ICU” nurses scramble at news of a patient backup

Most times, Johns Hopkins Hospital nurses bring patients to the intensive care unit post-surgery. Now, they can also bring the ICU to the patients.

Even with 32 beds, the Surgery Department’s two ICUs regularly are filled to capacity, threatening to leave surgery patients stuck in an operating room awaiting high-level care. The hospital has developed a solution—the surgery virtual unit, or “virtual ICU.”

Illustration by Shaw Nielsen

“It’s not a location. It’s the people,” explains Dorna Hairston, the interim director of nursing in the Surgery Department. “The virtual unit is about a pool of nurses who are dispatched to where the need is.”

Because they are taken out of their element to serve patients moved to the post-anesthesia care unit (PACU) rather than the ICU, the nurses must rely on judgment, experience, and decision-making skills. “The challenge is they don’t have all the resources at their fingertips like they do in ICU,” Hairston says.

The hospital launched a pilot virtual ICU in September, based on an idea designed by interim Chief Nursing Officer Deborah Baker, DNP, CRNP, and carried out by leaders of the Department of Nursing. After about three months, the administration stopped to address the most critical logistical problems, such as having those proper resources—equipment, medications, physical space—in place. In January, the hospital again rotated nurses onto the six-week shift in the virtual unit.

“I became more adaptable than I have ever been. Piloting the virtual ICU absolutely made me a stronger nurse.”
— Kerri Weinstein, RN

Kerri Weinstein, RN, one of the volunteers for the pilot, says the rotation was one of the most challenging experiences she’s faced in more than five years at Johns Hopkins. It was also one that stretched her skill set beyond what she thought possible. “I became more adaptable than I have ever been,” she says. “Piloting the virtual ICU absolutely made me a stronger nurse.”

A hospital taskforce—made up of surgical nursing leadership, perioperative leadership, pharmacy, respiratory therapy, RNs, and others—now meets every other week to continue improving the care the virtual unit nurses can provide.

Besides helping post-op patients get to ICU-level care sooner, the virtual unit also reduces OR holds—people waiting for a bed in intensive care—which eliminates delays for the next surgery.

“If we can get patients out to the level of care they need, the room can get prepped and the next patient can come in as scheduled,” Hairston says. “Patients are already anxious because of surgery, and waiting causes an undue stressor.”

Now back to her regular rotation, Weinstein has helped train the next set of virtual nurses. She and others from the pilot created a “virtual bible” with lists of resources and answers to common questions.

“The most important advice I give nurses starting in the virtual ICU is to be flexible and just go with the flow,” Weinstein says. “You can be called on to do any number of tasks at any moment. … Flexibility and adaptability are probably the two most important qualities in becoming successful in the virtual ICU.”