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Improving Care in Progressive Care Units Through Telehealth

As COVID-19 cases have surged this winter, hospitals across the nation have struggled to meet the needs of severely ill patients. Many facilities are facing a shortage of beds and staff members to provide adequate care. By early December, a record number of 100,000 patients were hospitalized with COVID-19, putting a fearsome strain on hospitals and staff.

Against this dire backdrop, the value of telemedicine has never been so clear. For example, the “tele-ICU” uses real-time audio, video, and electronic monitoring to connect critically ill patients to a dedicated team of intensivists and critical care nurses who are based in a remote telehealth center. The benefits of tele-ICU have been well-documented: in addition to preserving the health and safety of healthcare workers, hospitals using tele-ICU have reduced mortality rates, safely decreased the average length of stay for patients, and improved adherence to clinical best practices.

The value of telehealth isn’t confined to the ICU. Researchers have now shown that using telemedicine within hospital progressive care units (PCUs) also has a positive impact — for patients and hospitals alike.

What is a Progressive Care Unit?

Progressive Care Units (PCUs) were introduced as a way to manage hospital patients who need an intermediate level of care: more care than is provided on a general medical floor but less than in ICUs, where many patients require ventilator support and continuous invasive monitoring. Also known as “step down” or “high dependency” floors, progressive care units are often the next step for patients leaving the ICU — patients who need monitoring because they are at high risk for complications. Patients in PCUs still need a high level of skilled nursing care and surveillance but they are more stable than patients in ICUs.

The Impact of Telemedicine in the PCU

Can telemedicine be effectively used to manage the treatment of patients in progressive care units?

That’s the question a team of researchers addressed in a large-scale study of a health system in Florida. Published in Critical Care Medicine, the study was the first of its kind. “Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in PCU settings,” the research team noted.

Using a retrospective, observational approach, the team examined primary data from patients admitted to PCUs between December 2011 and August 2016 across five hospitals in the South Florida region. Since not all PCU beds at these hospitals were equipped to use telemedicine, patients who did not receive telemedicine served as the control group. In total, the researchers examined the experience of 16,091 patients, including 8,091 admitted into telemedicine PCUs and 8,000 admitted into non-telemedicine PCUs.

What did they find? First, patients in the telemedicine PCU group were 44% more likely to survive compared with patients in the non-telemedicine PCU — even accounting for the fact that patients in the telemedicine PCU were older and had higher disease severity and risk of mortality. Second, patients in the telemedicine PCU group saw a decrease in their hospital length of stay, when compared to the control group. And finally, decreases in mortality and length of stay among patients in the telemedicine PCU group were achieved “without substantial cost incurrences” to hospitals, the study found.

Transforming PCU Care Through Telemedicine

Progressive care units are gaining traction in hospitals across the nation as a strategy for freeing up beds in ICUs for the most acutely ill patients — a chronic challenge that has only become more critical during COVID-19. The American Association of Critical-Care Nurses first recognized progressive care as a nursing specialty in 2004 and today it is one of the fastest growing nursing specialties.

The growth of PCUs will only continue, researchers predict, as a result of the country’s aging population, increasing costs of care, and shortage of intensivists. Simply put, hospitals cannot afford to admit low-risk patients to costly ICUs just for monitoring purposes.

Just as telemedicine has proved to be an effective strategy for improving — and expanding — care for patients in the ICU, it has the potential to improve care delivery in PCUs by allowing for additional remote monitoring of critically ill patients.

Whether a patient in the progressive care unit is recovering from a stroke, has started a potent drug regimen that requires monitoring, or has recently suffered a heart attack, telemedicine allows an on-site caregiver to connect with a remote expert intensivist. With access to the patient’s vitals and electronic medical record, the off-site providers can write orders, provide continuous monitoring, and answer important questions.

In the months to come, equipping more progressive care units with telemedicine capabilities could improve patient outcomes and bring sorely needed expertise to hospitals without intensivists on site 24/7, especially for rural hospitals, which are particularly vulnerable to the shortage of critical care specialists.

Learn how Caregility can provide the technological support you need to equip your step-down unit with around-the-clock monitoring of critical care patients.

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