Improving Critical Care: Tele-ICU Safety, Savings, and OutcomesBy: Irene Goliash
COVID-19 has strained the critical care environment, with shortages of Intensive Care Unit (ICU) beds, ventilators, and personal protective equipment. The national shortage of intensivists — predicted to hit 7,900 critical care physicians nationwide during the pandemic — has exacerbated the challenges of overwhelmed, understaffed, and, often, undersupplied, ICUs across the country.
There is a silver lining: The pandemic has sped up healthcare’s adoption of the tele-ICU, which is proving to be a critical tool in providing outstanding patient care and strong outcomes, while preserving the safety of healthcare workers.
Just what is the tele-ICU?
The tele-ICU uses real-time audio, video, and electronic monitoring in a critically ill patient’s room that connects 24/7 to a team of intensivists and critical care nurses in a remote telehealth center. Through audio-video, the remote center clinician speaks to the onsite caregiver, giving expert guidance and helping to monitor the room and patient. The remote telehealth center has access to the patient’s vitals and electronic medical record and can write orders. Patients receive continuous monitoring. And the bedside team has instant access to experts and specialists.
Cutting-Edge Tele-ICU Technology
I have 35 years of experience in nursing, with primary bedside experience as a critical care nurse at Georgetown University Medical Center and the Washington Hospital Center. In 2003, I used my bedside expertise to provide clinical guidance in the implementation and sustainment of some of the first tele-ICU programs, in response to the shortage of critical care providers.
In the two decades since the concept of the tele-ICU was first introduced, and especially during COVID-19, much has changed, thanks largely to advances in tele-ICU technology. With the right visual tools, today we can monitor patients around the clock and intervene from anywhere. The benefits of tele-ICU are huge, especially for a critical care unit that may not have an intensivist onsite through the night shift.
Connecting Specialists and Ensuring Best Practices
Many of the sickest patients in the ICU are put on mechanical ventilation. Metropolitan hospitals generally have intensivists who are experts on respiratory failure and ventilation equipment. But many smaller hospitals may only have an intensivist at the bedside during the daytime hours, or none at all.
When you have 24/7 access to experts via remote ICU monitoring, onsite staff can better monitor patients. In one recent case, a bedside nurse was concerned about her patient, who had COVID-19. She contacted the telehealth center and spoke to the virtual critical care (VCC) nurse, who remained on camera to monitor the patient with the bedside nurse for more than an hour. When the patient decompensated, the virtual critical care nurse communicated requests for equipment for intubation and arterial and venous catheter insertions to staff members outside the room, while also providing guidance to the bedside team that was hands on with the patient.
Such guidance is more valuable than ever today, when the majority of nurses working in ICUs have limited experience there, according to research published in Critical Care Nurse. (A 2019 survey by Atrium Health found that nearly three-quarters of critical care RNs had less than five years of nursing experience.) The tele-ICU provides instant access to an expert for a question about a drug or a patient’s cardiac rhythm.
Access to experts also enhances adherence to best practices, whatever the experience level of the on-the-ground care team. Take the case of venous thromboembolism (VTE) prophylaxis monitoring: a life-threatening condition in critical care that must be quickly addressed when a patient is admitted to the ICU. With tele-ICU, the remote team is well-versed in the complexities of VTE prophylaxis monitoring, including the importance of starting it quickly. The telehealth intensivist can easily see which patients don’t have orders for anticoagulants or compression stockings, then enter the orders, and communicate with the team on the ground.
Reducing Patient Complications, Expanding Access
The longer patients are in the ICU, the more prone they are to complications. ICU monitoring by a remote team means fewer complications for the patient and quicker transfer to the floor. In one major study involving 17 ICUs around the country, researchers found that hospitals using tele-ICU programs reduce the average patient’s stay by more than a third, and reduce mortality rates by an average of 29 percent. In that particular study, that meant that 390 patients lived longer than they would have lived had they been treated in an ICU without access to telemedicine.
Reducing the patient’s length of stay in the ICU also helps free up more beds for critically ill patients, a chronic challenge for many hospitals that has been exacerbated during COVID-19.
The savings for hospitals — and the healthcare system — are considerable. A study of the eICU program at UMass Memorial Medical Center found that a tele-ICU or e-ICU program with centralized bed management control can increase case management as much as 44 percent and improve contribution margins by almost $53 million.
Improving Care — and Protecting Caregivers — During COVID-19
Since last spring, many ICUs across the country have seen an onslaught of very sick patients, all while there has been a shortage of personal protective equipment for healthcare workers. Hospitals using tele-ICU programs can keep eyes on the patient through virtual rounding without exposing staff to the coronavirus and save precious PPE resources.
Another benefit: Staffing shortages have occurred in some hospitals due to staff exposure to the coronavirus. With the tele-ICU, intensivists who are asymptomatic can work remotely and continue to treat patients.
Critically ill patients with COVID-19 have also seen benefits. Providing emotional support to patients and their families is vital to critical care. During the early days of the COVID-19 pandemic, families weren’t allowed into the ICU, and even now visitors continue to be severely restricted. I’ve heard many, often heartbreaking stories, of ICU nurses holding the iPad or a cell phone so patients could talk with family or say goodbye.
Tele-ICU programs allow for much more effective communication between patient and family and patient and caregiver. I’ve seen countless virtual critical care nurses provide comfort to a patient who has limited physical interaction with a bedside team. Our Caregility platform can also invite family members or a chaplain into the call for frequent, virtual visits to provide essential psychosocial patient support.
Since its inception in the early 2000s, the tele-ICU has held the key to best practice in critical care. Today, the tele-ICU holds more than promise: It is proving to be the right solution, right now.
For a real-world example of how tele-ICU helped a healthcare organization improve and expand critical care, read our case study.