For at least the past decade, the United States has faced a shortage of intensivists. Partly in response to this shortage, in 2000, Norfolk, Va.-based Sentara Healthcare opened its tele-ICU — the first remotely operated monitoring and treatment center for intensive care unit patients in the country.
While healthcare has advanced technologically in the past 15 years, the country still faces a physician — and intensivist — shortage, and is turning to telemedicine to help mitigate this gap in care. It's a journey the telemedicine team at Sentara has experienced firsthand.
Around the early days of Sentara's tele-ICU — a model that allows critical care nurses and intensivists to remotely monitor and care for patients — there was a nationwide need for more intensivists in the ICUs. Steven Fuhrman, MD, Medical Director of Sentara's eICU, says studies published around that time indicated the country needed 35,000 intensivists to staff all the ICUs in the country, but there were only approximately 6,000 practicing. The demand for intensivists, he says, stemmed from a number of peer-reviewed studies indicating ICUs which were staffed by intensivists had better care quality outcomes, such as lower mortality, fewer morbidities, and shortened lengths of stay.
A 2008 fact sheet published by The Leapfrog Group shared results of a survey conducted at Baltimore-based Johns Hopkins Medical Institutions which found ICUs where intensivists managed or co-managed all patients had a 30 percent reduction in hospital mortality compared to ICUs where intensivists manage or co-manage some or none of the patients.
These types of studies, Dr. Fuhrman says, were Sentara's push to figure out how to get intensivists involved with the care of more patients in the ICUs, especially at separate, distanced Sentara hospitals. "The tele-ICU is a way to extend the availability of critical care expertise for a longer part of the day, over a greater distance, as well as over more beds, to eliminate the travel time between patients whether in the same or different hospitals," he says.
Currently, the U.S. is still in the midst of a physician shortage, intensivists included. But a new key driver to tele-ICU programs is the efficiency such tele-ICU services create, Dr. Fuhrman says. Instead of just allowing intensivists to be available to more patients, Dr. Fuhrman says tele-ICUs help clinicians prioritize and triage patient needs from the tele-ICU setting.
In a regular ICU, Dr. Fuhrman says clinicians largely take care of patients based on where the clinician happens to be located, meaning a clinician will care for a patient by virtue of the fact that the clinician is in that particular ICU or at that particular hospital. This element of bedside care doesn't take into consideration patient needs, as a patient in a different ICU may have a more pressing clinical situation.
"There's efficiency in the tele-ICU space that is not afforded at the bedside. We can address the issues in individual patients based on need, not on the fact that I happen to be in one particular unit or at one particular hospital at that moment," Dr. Fuhrman says. "That turns the delivery of critical care on its ear, and that was a concept that has been realized in this last decade and proves to be part of what accounts for significant outcome benefits that have been found with tele-ICU implementation."
These benefits, though, were a hard sell to clinicians when Sentara first implemented the program 15 years ago.
John Bowers, MD, a pulmonary critical care physician with Sentara's Medical Group, has been working with Sentara's tele-ICU since its inception. He says one of the key challenges they faced when introducing the technology was skepticism and hesitation that this technology was worth it. "Most pushback came from individual bedside clinicians who weren't convinced of the value of telemedicine and were a bit afraid their role was going to be either eclipsed or second guessed by this other application," Dr. Bowers says.
Now, acceptance of the technology is no longer an issue, but Sentara does face some hurdles as it tries to expand the reach of its tele-ICU. Dr. Bowers says the health system is seeking to cover more beds under the tele-ICU program, which will require manpower and capital resources. Currently, Sentara's tele-ICU program uses Epic Monitor to cover 108 beds, and the system hopes to expand to covering 120 beds.
"We're in an era of cost containment in healthcare, and embarking on new projects either with new manpower costs or capital costs is difficult," Dr. Bowers says.
Though new projects and initiatives certainly have their obstacles, Dr. Bowers says the tele-ICU project at Sentara has certainly been an asset for the health system, a sentiment which can be extended to all tele-ICUs across the country.
"From a personal standpoint, I'm a physician near the end of my career, and this has been an exciting project to be involved with," Dr. Bowers says. "You get the feeling you're on the cutting edge of something good. You're learning a new skill, and it's helped keep me energized and feeling as if I'm a valuable asset to our healthcare system."
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