Staffing the ICU: Are you really going to be able to recruit sufficiently?

Hospitals and hospital systems across the United States continue to work diligently to address their ongoing challenge of hiring sufficient intensivists to provide care in their intensive care units.

Despite continuous recruiting efforts, however, many hospitals are still left short of critical care specialists. An expanding shortage of intensivists, a persistent increase in the 65+ population with its heightened risk for chronic illnesses, growing ICU utilization and the inevitable imbalance between where intensivists live and where they are needed have left a relatively small group of ICU staffing “haves” and a growing group of ICU staffing “have nots.”

Compounding this challenge is the reality of intensivist burnout. Critical care professionals have one of the highest rates of burnout in the healthcare industry. A recent Medscape National Physician Burnout and Depression Report found that 48 percent of critical care physicians reported burnout, leading some intensivists to leave the profession for less demanding positions. There are also indications that physicians are choosing to avoid the profession altogether.

The above trends have left hospitals and systems struggling to meet established care standards. In 2015, only 47% of reporting hospitals met The Leapfrog Group’s standard for ICU physician staffing. More than half of reporting hospitals fail to provide Leapfrog’s research-based care guideline of 24/7 intensivist oversight.

The imbalance between aggregate intensivist supply and demand, exacerbated by the geographic imbalance between where the intensivists are and where patient need is highest, presents significant staffing challenges for hospitals and hospital systems. Compensation inflation and increased use of locums are among the results. Recruitment costs alone associated with hiring a full-time intensivist can easily exceed $100,000.

Telemedicine care models offer a solution
Given the limited supply of intensivists and the cost to attract and retain them, technology-enabled critical care delivery models provide a compelling option for many hospitals and systems. Tele-ICU is one such model. Tele-ICUs leverage clinical resources (intensivists, advanced practice providers, respiratory therapists and critical care nurses) in integrated care centers and deliver those resources to the bedside via tele-technology, independent of the location of the patient or provider. Tele-ICU services enable hospitals and hospital systems to offer the standard of around-the-clock ICU care without needing to conquer the mounting challenges and uncertainties associated with securing bedside intensivist staffing. Additionally, tele-ICU programs provide incremental benefits, including increased focus on best-practice compliance as well as insightful and timely reporting. It represents an increasingly mainstream paradigm shift in patient care, enabling hospitals and hospital systems to do more than simply run ever faster on the bedside staffing treadmill. Tele-ICU services provide a flexible, stable and consistent foundation for ICU staffing.

Not only does the tele-ICU leverage technology to more broadly and efficiently deploy scarce critical care skills, but it enables the recruitment of intensivists independent of specific hospital locations, providing access to intensivist talent while still enabling the physicians to reside in preferred locales. This effectively “flips the script” by bringing the intensivists to the patients instead of bringing the patients to the intensivists. In this way, deployment of a tele-ICU solution actually overcomes a key hiring challenge faced by many hospitals.

Interestingly, the presence of a tele-ICU care program at a hospital or hospital system has proved to be a positive influence on the hiring and retention of existing bedside staff by offering consistent 24/7 support. Hiring notices for intensivists and CCRNs increasingly highlight the inclusion of tele-ICU care, which complements their bedside teams with a remote care team partner.

Because of the scale involved in a significant tele-ICU operation, a tele-ICU partner can also insulate a hospital or hospital system from the up-and-down variability associated with intensivist attrition. The very moment an intensivist staff is fully built out at the bedside, the hiring process is likely to begin again in preparation for turnover. It is much easier for an at-scale tele-ICU operation with a large clinical team to insulate an individual hospital or an entire hospital system from this inevitability.

Research has shown the clinical and economic benefits of tele-ICUs, including decreased mortality rates, decreased incidence of ICU complications, decreased ICU length of stay and lower ICU costs. One key factor contributing to these benefits is the fact that tele-ICU supports bedside staff 24/7, enabling around-the-clock delivery of high-quality care driven by best practices. At a time when many ICUs are adjusting to substantial resource constraints, tele-ICU enables incremental comprehensive care to patients and their families, care that improves clinical outcomes and saves lives. In addition, tele-ICU capabilities allow most hospitals to retain higher acuity cases than would otherwise be the case, enabling patients to stay closer to home which, in turn, delivers a more satisfying experience for patients and their families while enhancing a hospital’s reputation and revenue.

Adoption of a tele-ICU program effectively addresses many of the challenges created by scarce staffing resources and an increasing demand for critical care services. Results show that partnering with a tele-ICU program increases critical care team satisfaction and decreases care team turnover rates – both of which are positive outcomes for hospitals and hospital systems. System executives and bedside care teams feel better supported when they know they can rely on the additional eyes, ears and expertise inherent in a tele-ICU program.

Tele-ICU: an effective alternative to a staffing-only approach
For many hospitals and hospital systems, regardless of size or location, it is becoming increasingly clear that a bedside staffing-only approach to ICU care is risky and not fully achievable. Tele-ICU solutions represent an important alternative and are increasingly utilized to improve clinical outcomes while simultaneously addressing the shortage of intensivists and reducing the cost of ICU care. As the supply of intensivists remains stagnant and recruitment and retention expense increases, the growing utilization of tele-ICU programs stands as a proven bridge to achieving the clinical goals that are the mission of hospital ICUs.

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