Addressing ICU burnout: using tele-technology to expand the team

It likely won’t surprise any intensivist to learn that the 2018 Medscape National Physician Burnout and Depression Report shows that critical care physicians claim the highest rate of burnout (48 percent) amongst any physician group.

While the study points to several factors that contribute to burnout and offers some tactical strategies to address the issue, it is clear – especially to intensivists who live the daily experience of caring for critically ill patients – that there is no single cause, and therefore, there is not a lone “silver bullet” solution. Rather, burnout is a widespread, complex issue that impacts each individual intensivist differently based on his or her unique personal experience and the specific setting of their practice.

Many intensivists – myself included – were originally attracted to the specialty of critical care for its intellectually-challenging fast pace, its complex problems and diagnoses and the opportunity to develop and use a unique skill set to directly and significantly impact patient outcomes in the intense setting of life-threatening illness. From the outset, all intensivists understand and accept the weight of the responsibility that stems from the privilege of caring for critically ill patients and their families in the high stakes environment of the ICU. However, as intensivists mature in their careers, many find themselves questioning for a number of personal reasons, including the absence of balance and true time off from the emotional and intellectual demands of the work, whether continuing to practice as an intensivist is a sustainable choice.

External trends further exacerbate the burnout issue amongst intensivists. The current state of healthcare, with its complicated reimbursement structure, increasingly litigious environment and consistent call for expanded oversight and documentation places stress and pressure on both healthcare organizations and physicians beyond what is derived solely through providing the medical care itself. Additionally, the growing intensivist shortage and expanded demand for comprehensive critical care coverage spreads the current supply of practicing intensivists increasingly thin as physicians do their best to fill the resulting gaps.

While there is no single, easy remedy which alone combats the many challenges contributing to high burnout rates in the intensivist community, the introduction of tele-ICU into hospitals and health systems has shown encouraging developments in helping to address the problem. Each hospital or health system implements tele-ICU for reasons unique to their own critical care environment. However, in addition to achieving overarching objectives for improved patient outcomes and delivering the standard of 24/7 intensivist oversight, hospitals are finding tele-ICU programs are significant satisfiers for their bedside intensivists and potential new recruits.

Remote tele-intensivists are integrated with hospitals to access real-time patient data and offer continuous monitoring and care of ICU patients. In doing so, they offer their colleagues at the bedside around-the-clock collaborative support. Most notably, the inclusion of tele-ICU affords bedside intensivists the ability to more fully step away from bedside duties when they leave the hospital, promoting a better work-life balance as well as the chance to recharge and gain perspective. Because their ICU patients are comprehensively transitioned to a tele-intensivist colleague in their absence, bedside intensivists typically feel freed to more fully focus on other aspects of life knowing that they will be asked to re-engage with ICU care only when their involvement is absolutely required. For example, the tele-ICU intensivist can absorb the calls, consultations and questions that arise whether the bedside intensivist leaves for an off-site meeting, to see patients or to join a family dinner. The tele-intensivist can also serve as a knowledgeable resource for nurses, patients and patient families. Additionally, the inclusion of tele-ICU offers bedside intensivists a greater degree of support while they are on-shift at the hospital. This may include addressing urgent issues when the bedside intensivist is tied up caring for another patient or offering additional manpower when patient census is especially high.

With an existing intensivist shortage and the growing need for critical care services, it is more important than ever to address physician burnout. In addition to achieving the primary goals of improved patient outcomes and the standard of 24/7 intensivist oversight, tele-ICU represents one of many approaches that hospitals and health systems can pursue to address burnout. Action must be taken to ensure that the practice of critical care medicine is a sustainable choice for intensivists, compatible with the evolving personal and professional realities over the lifetime of a physician’s career. The lives of those we love may well depend on our ability to successfully meet this challenge.

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