How telehealth, remote monitoring can enhance ICU patient care

Virtual technology is helping transform the delivery of patient care. From remote monitoring to telehealth services, virtual care is continually developing to bring remote physician specialists directly to the patient's bedside.

During a May 30 webinar hosted by Becker's Hospital Review and sponsored by Philips, Ashok Palagiri, MD, medical director at Mercy Virtual, and Adam Seiver, MD, chief medical officer of monitoring and analytics and therapeutic care at Philips, discussed the advantages telehealth services present to patient care and how the technology helps support clinician satisfaction.

Clinicians are the driving force behind Mercy Health's virtual care center, which established its telehealth focus from a clinical perspective, Dr. Palagiri said. The center, which opened in 2006, is home to a large clinical team but no patient beds. Mercy Health equipped its center with two-way video cameras, real-time vital signs for remote patient monitoring as well as online-enabled medical instruments. The telehealth technology helps Mercy Health providers reduce the workload of bedside caregivers at hospitals and health systems that partner with the virtual center.

Pursuing telehealth from the lens of clinicians along with keeping the patient at the center of care is the driving force behind Mercy Health’s virtual care center. Mercy Virtual initially started with just virtual ICU services in 2006, and then built its large virtual care center in 2015 which has been called by news outlets the ‘hospital without beds’. The virtual care center’s service lines utilize two-way video cameras and real time alerts for remote patient monitoring. By utilizing telehealth technology and advanced analytics, Mercy’s virtual care center helps reduce the burden of work felt by the bedside clinicians at their partnering facilities. This in turn allows the bedside clinicians to function at the top of their licenses.

"Clinician turnover rate is secondary to the sheer amount of work and not enough resources for bedside caregivers," Dr. Palagiri said. "[Our partnership helps] make clinicians feel rewarded when coming to work and [know that] they have help from afar with the telehealth perspective." Dr. Palagiri spoke to the significance of the current burnout that physicians and nurses are experiencing across the U.S., and explained that virtual care is not only sustainable, but also a necessity for the future of the patients we all serve.

All hospitals can benefit from telehealth, but it is important to note that not all virtual care solutions are one size fits all, Dr. Palagiri said. Telehealth services can help support large health systems, which may have 24/7 resources but are stretched too thin across departments. Larger health systems can benefit from virtual care assistance with maintaining consistent quality with best practices across multiple units, whereas smaller health systems require the access to an intensivist for the care of critically ill patients definitively at night and often also during the daytime. Finding the appropriate use case for each facility is necessary to have a successful telehealth program.

"Being an intensivist, my stance is any patient in the ICU deservers intensivist care," Dr. Palagiri said. "Tele-ICU [care] allows [hospitals to] break down barriers as many times as needed throughout the night."

There is a long-standing dichotomy of daytime versus nighttime care in the ICU. At night, nurses are left with the decision as to when to call the nighttime physician, whether they are busy managing the entire hospital or at home. With the use of virtual care, intensivists can be leveraged across multiple facilities to help provide continuous 24/7 critical care. This leads to improved patient outcomes, better physician retention and improved clinician satisfaction, Dr. Palagiri explained.  

Dr. Palagiri and Dr. Seiver also discussed different methods and observations that Mercy Health has made during its 10-plus years of experience in virtual care. Dr. Palagiri provided various insights for hospitals and health systems looking to implement virtual care.

Specifically explain how telehealth will help improve patient care

To gain clinicians and providers' approval on new telehealth technology, Dr. Palagiri and Mercy Health discovered that their telehealth program experienced the most success when the clinical teams at their partnering health system or hospital already knew about the program and understood what it was. To further support understanding, Mercy Health uses an implementation team which communicates directly with the organization's bedside caregivers and determines what their current pain points are and what their expected pain points are when partnering with the virtual ICU team. This forms a partnership between clinical teams rather than a vendor and client relationship.

Develop a multi-faceted communication strategy

When implementing new telehealth technology, the health system must ensure every employee who will encounter the telehealth service has been briefed. Medical staff have very busy schedules, so it can be easy for an email or meeting about the new services to be missed. Recognizing this, Dr. Seiver asked Dr. Palagiri for any advice or tips he applies to increase medical staff's engagement with communication.

"We have layers that help reach providers at the bedside," Dr. Palagiri said. "We have an implementation team [and a] clinical team, where personally what I will do is reach out to those physicians and find time to connect to ease way of communication."

First-time training clinicians in virtual care isn't easy

For health systems and hospitals just embarking on the virtual care journey, it can be difficult to decide how to train physicians and nurses to become virtual care providers. Dr. Palagiri recommended establishing a training program for the first couple of months that new hires are onboarded to ensure they understand the telehealth technology.

To access the webinar, click here.

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