Are Tele-ICUs The Solution To The Critical Care Crisis?
America’s ICUs are in crisis. Consider these staggering statistics: Today’s ICUs Serve 4 million patients annually, with roughly 20 percent mortality rates among those treated. On average, every patient admitted to the ICU suffers 1.7 potentially life threatening errors every day and estimates show that patients only receive half of the therapies that they should. And 50,000 patients annually die in the ICU from preventable deaths.
But research indicates that ICU patients have lower risks of death and shorter ICU and hospital stays when an intensivist is on duty in the ICU and oversees patient care. The mortality reduction has ranged from 15 to 60 percent lower than in ICUs where there are no intensivists. However, the Committee for Manpower for Pulmonary and Critical Care Services predicts a shortage of 10,000 ICU physicians, called intensivists, who have extra training to specialize in the care of the ICU patient. This national shortage of intensivists makes it extremely difficult to find intensivists that can provide 24/7 care for today’s ICU patients.
The answer to solving this crisis has emerged from the world of telemedicine.
Tele-ICUs Improve Outcomes, Save Lives
A tele-ICU uses state-of-the-art equipment to connect patients to intensivists 24 hours a day, seven days a week, from anywhere in the country – or the world. These doctors and nurses, at a centralized location, use remote-control cameras, video conferencing and continuous monitoring technology to access real-time patient information – including vital signs, physiologic data, medications and lab results. The intensivists and nurses also have access to patients’ complete medical history and local attending physicians’ care plans and can talk to patients directly. This technical leverage allows a qualified medical team to care for large numbers of patients and meaningful impacts the labor shortage.
On a personal note, this technology has changed the course of my career and allowed me to have an impact on patients in ways I would have never imagined. In my work early in my career as an intensivist, I saw that there is a significant lack of access for all patients to expert ICU treatment. In addition to lack of access, there is a lack of a systematic approach to the care of the patient. In fact, medical literature demonstrates that there is a lag of more than 15 years between evidence-based care and delivery to the patient. This statistic is unacceptable, and I saw that a standardized approach to the care of the ICU population delivered by telemedicine was a way to help the problem. With the notion that every ICU patient, no matter where they live, deserves to be treated by an intensivist, in 2005 we launched Advanced ICU Care, the first and only private tele-ICU company in the nation.
My goal, through telemedicine technology , was to create a completely new model of bringing the highest standard of ICU care to hospitals that otherwise would not be able to either recruit the appropriate number of intensivists, establish an ICU management program, or afford the technology on their own. Previously, the technology we use had been acquired only by large, multi-hospital systems with in-house intensivists. Few people were familiar with the concept at the time, so it was a risky endeavor to convince client hospitals and investors to commit to our program.
The technology we use, manufactured by Philips VISICU, uses sophisticated algorithms to detect and advise our clinical staff in St. Louis to important trends and changes in our patients’ condition from any of our partner hospitals. The program uses extensive reporting – including daily management and ICU benchmarking of outcomes. Our site provides some examples of what the technology looks like to the patient.
Utilizing the technology and our unique process improvement program has led to great results for the patients we care for and for my company. Our results are consistent with the results of various academic studies that continue to prove that tele-ICUs save lives. Our partner hospitals – 17 hospitals in nine states – have found 40 percent reduction in ICU mortality on average and 25% length of stay improvement as well as improved performance across key quality best practice measures.
Two recent studies have added to the consensus that tele-ICUs are the key to improving America’s critical care. “Hospital Mortality, Length of Stay and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes,” – published in the Journal of the American Medical Association – found that tele-ICU intervention was associated with lower hospital and ICU mortality, shorter hospital and ICU lengths of stay, significantly higher rates of adherence to critical care best practices and lower rates of complications.
And a study released in December by the New England Healthcare Institute (NEHI) and the Massachusetts Technology Collaborative also found that patient mortality decreases significantly – as much as 36 percent – when hospitals adopt tele-ICU technology.
The Future of America’s ICUs
These results prove that tele-ICUs should – and most likely will – be an integral part of America’s critical care future. The government is taking steps to pave the way to that future as well. In May, the Centers for Medicare and Medicaid Services (CMS) took a huge step in support of telemedicine by implementing a new credentialing and privileging process for telemedicine providers. Under the new rule, hospitals will no longer have to credential and grant privileges to each clinician who provides telemedicine services to its patients from an off-site location. Instead, hospitals can rely on the credentialing and privileging decisions of the clinician’s home hospital or facility.
And in June, Health and Human Services Secretary Kathleen Sebelius pointed to tele-ICUs the type of innovation that can serve as a model for providers around the country as they try to cut costs and improve patient safety and care.
As regulations make it easier for tele-ICUs to treat patients, technologies continue to improve. Doctors are now using mobile apps and devices such as iPads to help detect sepsis in the ICU. As a CEO and an intensivist, I am proud to be part of this revolutionary time in critical care services. This is just the beginning.
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Mary Jo Gorman, M.D., MBA, is the CEO of Advanced ICU Care, a medical service company headquartered in St. Louis, Mo., which provides high-quality care to patients in the intensive care unit. For more information, visit:www.icumedicine.com.
*This blog post was originally published at Medgadget*
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