Up Your ICU Management Game with a Tele-ICU Program

This content is sponsored by Advanced ICU Care®.

The demand for intensive care services is rising. This doesn't come as a surprise; the physician shortage has been predicted for some time now, and intensivists are no exception to the trend. For hospitals, dealing with care shortages while maintaining excellent standards of care is not easy. Indeed, intensive care suffers from many of the same management problems facing the rest of medicine; the Leapfrog Group estimates that various factors, including inadequate staffing and sub-par management contribute to approximately 55,000 preventable deaths in intensive care units in the U.S. each year.

Bridging the care gap in the ICU is particularly important, largely because of the department's cost and widespread clinical impact. About 40 cents of every dollar spent on operations in a hospital is spent in the intensive care unit. This statistic comes with an additional problem: Adults 65 and over use the ICU three times as often as those under 65, which, with the growing baby boomer population, means the ICU is becoming more resource-intensive than ever.

According to Mary Jo Gorman, MD, CEO of Advanced ICU Care®, the nation's largest provider of tele-ICU services, technology plays a helpful role in enabling care improvements in intensive care. In particular, telemedicine bridges the gap between the need for services and the shortage of the people to deliver those services. Dr. Gorman and her team have been working to build these bridges through the company's tele-ICU solution.

Telemedicine has gained popularity in recent years because of its usefulness in cost savings and care quality. A 2013 study in CHEST Journal confirmed the benefits of ICU telemedicine. The 120,000-patient study showed telemedicine in the ICU is associated with shorter lengths of stay, lower mortality rates, faster case review, better use of performance data and improved adherence to best practices.

To Dr. Gorman, this is no surprise. "The big difference between ICU telehealth and other types of telehealth is that ICU patients are extremely fragile. [An ICU] must have information available second to second and have staff available in minutes. This is very different than in a program in which you have some time. Delivering successful care to an ICU patient has quite a different rigor," she says.

The Advanced ICU Care program helps meet this need for rigor through a team of centrally located critical care experts and clinicians who have patient information at their fingertips at all times. The team is constantly monitoring patients' vital signs, medications, labs, trends in patients' clinical status and outcomes of care, and it supplements the hospitals' delivery of care at any time, day or night, as a patient's condition changes. The Advanced ICU Care program has a robust implementation process, and electronic medical records and laboratory data are both connected, allowing collaborative virtual and real-time interactions between clinicians, patients and families.

With this collaborative effort, Advanced ICU Care can help hospitals engage in performance improvement in a cost- and health-sensitive area. Alleviating intensivist shortages allows hospitals' clinical leadership to focus their time and energy on patient care and care improvements.

Patient privacy is a top priority. All connections between the patient room and Advanced ICU Care are secure and HIPAA compliant. The video component of the program is only for consultations requested by the bedside team or by the Advanced ICU Care team, who introduce themselves when entering a room. When not in in use, the camera is turned to face the wall.

"From a patient's perspective, you're not always being observed, so the technology observation is not visually evident. But the tele-ICU adds an extra layer of care that allows the whole ICU team to identify dangerous changes in patient changes," says Dr. Gorman. "Of course there is no substitute for having someone at the bedside. The tele-ICU doesn't replace care at the bedside, but enhances it as the hospital's critical care team and the tele-ICU team collaborate. The tele-ICU can add value to a number of areas through acting as a management solution," she says. ICU services have the potential to be inconsistent at any time, but a tele-ICU program takes on some of the systemic stress. "Different things happen on Saturday than on Tuesday, and caregivers don't have a consistent 24-7 pattern of availability. The tele-ICU can increase the number of patients for which ICUs may safely care, because it increases care itself," says Dr. Gorman.

According to Dr. Gorman there are several challenges that that may encourage a hospital to consider the tele-ICU. "The biggest challenge is the nationwide shortage of intensivists. ICU efficiency and quality of service in the ICU are also top considerations we hear from hospital leadership."

It may also be an attractive marketing proposition. "In some markets, hospitals are looking for ways to differentiate themselves. The tele-ICU solution is a state-of-the art quality service and good differentiator in the community," says Dr. Gorman.

There is plenty of data to show the ICU is undermanaged, and with the intensivist shortage, that trend is expected to continue. Facing this systemic risk, hospitals are exploring alternative care delivery solutions to curb the shortage's repercussions on a piece of the healthcare continuum that is especially sensitive. "Really bringing good management — through meaningful analytics that can help clinicians adjust their practice — that's the biggest opportunity for facilities in terms of clinical and financial outcomes," says Dr. Gorman.

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