ICU Nurses at the Ryder Trauma Center at the University of Miami/Jackson Memorial Medical Center have a new high-tech colleague. CHICO (computer hospital intensive care operator) is a roving telemedicine robot that whirs quietly from bay to bay on the busy trauma unit looking in on patients with its digital monitor “face,” while uploading and transmitting patient data via secure Internet connection technology. CHICO, priced at $250,000 from InTouch Technologies, is the only remote presence robot in a civilian trauma center in the country. Looking like an upright vacuum canister with a computer monitor for a head, topped off in CHICO’s case with a jaunty cap, the robot allows an off-site physician to access patient records electronically, listen to a heart rate with the built-in stethoscope, and consult with other healthcare providers, patients, and patients’ families. The patient sees the face and hears the voice of the physician who is operating the system. “With CHICO, we can make rounds from a remote conference room next to the unit,” says Doug Houghton, ARNP, MSN, CCRN, referring to the technology that allows the robot to be wirelessly manipulated to turn in different directions, angle up or down, zoom in on equipment such as ventilators, and check vital signs on the bedside monitor. Recently, while an assistant was in the room conducting video conferencing rounds with CHICO, the patient in the next bed began to code. “The patient went into a hypotensive junctional rhythm. The assistant heard all the commotion behind her and turned CHICO around, zoomed in on the patient monitor, and saw the code just as it was beginning,” says trauma unit staff nurse Virginia Dweck, RN, CSN, CCRN. “Everyone from the rounding team came running and was at the bedside in seconds. CHICO sure earned his keep that day.” Healthcare providers can be even farther away than the conference room, Houghton adds. “For instance, when residents on call must look in on a patient at 2 AM that they are not familiar with, they can call the trauma surgeon at home who logs on to a computer, views the patient, and discusses treatment options...all in real time,” he says. Subspecialty experts can be brought to the bedside for virtual consults from anywhere in the world. The technology offers language translation. Managing CHICO CHICO is one of two telemedicine devices being tested on the trauma unit, which sees 4,000 patients a year, since last October. The other is a $20,000 table-mounted telemedicine apparatus. The smaller table-top device must be carried from room to room and an assistant must aim and adjust the unit manually. “Practically speaking, the smaller unit doesn’t have the cool factor of CHICO, but the table-top unit is probably a lot more feasible to use in remote locations such as rural areas or on the battlefield,” says Houghton. And the armless 5 1/2-foot-tall robot can’t pull back covers or perform hands-on patient care. A healthcare worker must be present to interact with the physician who is remotely operating CHICO when it’s necessary to, for example, remove a patient’s bandage to display a wound. And a human escort is needed to open doors or push elevator buttons. As a coworker, Dweck says her first impression was, “What is this thing and what is it doing in my workspace?” But now when it comes to the bedside, the staff ignores the robot. “There is no disruption or shift in dynamics that requires you to stop and talk as is the case with a human visitor,” she says. The patients’ reactions are a different matter. “At first I think the patients are a little shocked,” says Houghton. “I can see how it might be disorienting for patients who are not fully with the program. But the families think CHICO is pretty cool and seem to appreciate that their loved ones are in a place that is on the cutting edge of medical technology.” Surprise benefit of robots Official data is being gathered, but Dweck says that, anecdotally, the staff has seen a subtle change in infection rates for bacteria such as vancomycin-resistant enterococci (VRE), normal flora in the body that can flair up to infect the urinary tract, a surgical wound, or the bloodstream of a hospital-based patient. “A year ago, if one patient had VRE, the likelihood is that the patient in the bed next to him would develop it as well. Open bays contribute to the spread of infections and VRE is very difficult to treat,” says Dweck. “We haven’t had anyone with VRE in a long time. We think that with the robot has played a significant role in this turnaround.” The rounding team on an average day can number up to 30 people including nurse practitioners, a pharmacist, attending physicians, three or four residents, one or two trauma critical fellows, and a number of students. “The disadvantage to this is that with all the multi-drug resistant organisms we have today, dragging a team of that size through the unit from bedside to bedside can be a hazard in terms of infection control,” says Houghton. “After the first twenty minutes, the team is leaning on the bed, leaning on the side table, and touching the side rails. With only the robot and a healthcare worker at the bedside, this has reduced the chance of spreading infection.”

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