How tele-ICU is revolutionizing access to life-saving care
A patient in a remote area of Vermont lies in bed at a small, rural hospital with a critical lung condition that the clinician on site has never before treated. Instead of waiting for a med-flight to transfer the patient to another location, the care team sets up a virtual visit with a clinician in Chicago for the patient’s immediate care. They’re able to work through the details of the needed treatment without him ever leaving the area.
The notion that critical care medicine could be provided virtually began to take shape more than 20 years ago as the U.S. looked for ways to combat a growing shortage of critical care physicians. Unfortunately, the pandemic exacerbated the situation. The past three years have resulted in high rates of burnout among physicians—especially those in critical care, who saw the bulk of hospitalized COVID-19 patients.
A critical need
“The shortfall of critical care physicians is only expected to worsen,” says Konrad L. Davis, M.D., FCCP, FCCM, Captain (Ret.) in the U.S. Navy, Chief of the Division of Pulmonary & Critical Care at Scripps Memorial Hospital La Jolla, and Clinical Professor of Medicine in the Scripps Clinic Medical Group. “By leveraging technology with tele-critical care (also called tele-ICU), you can allow a smaller number of physicians to extend that care expertise to a larger number of (potentially) geographically dispersed patients.”
Dr. Davis, who recently retired from the U.S. Navy after 21 years, started the Military Health System tele-critical care program in 2012. Now practicing in-person critical care at Scripps, he’s working with the health system as it explores tele-ICU.
While many health systems have incorporated telemedicine as a standard way to deliver healthcare, tele-critical care is an emerging category that more hospitals and health systems like Scripps are beginning to seriously consider. The tele-ICU solution enables specialized physicians to manage care for seriously ill patients located in parts of the country where it is difficult to find critical care expertise. The U.S. military, Department of Veterans Affairs, Banner Health and Mercy Virtual are among the early adopters effectively operating tele-ICU programs based on their patient populations’ needs.
How tele-ICU works
The patient is located at what’s known as the originating site, which is usually a hospital. The critical care provider is located at what’s called the distant site. “At the originating site, remote support can be provided round-the-clock, partial or as-needed,” Dr. Davis explains. At the distant site, there are different models for providing care. “A hub-and-spoke model is where a centralized group of providers support multiple facilities that are part of a health system. A decentralized model means the critical care providers could be located just about anywhere.”
Communication and information technology advancements like continuous remote monitoring allow critical care providers to manage up to 150 patients in a tele-ICU setting, rather than 10 to 15 patients in person. Healthcare professionals like advanced practice providers (APPs) and anesthesiologists handle procedures in the absence of a critical care physician provider on site.
“Because medicine is becoming more and more digitized, it can be practiced increasingly through virtual tools and care models. It doesn’t always need to be hands on,” says Dr. Davis. “A nurse can place a digital stethoscope on the patient’s chest and the intensivist can listen remotely.”
Barriers to adoption
Reimbursement for tele-ICU had been lower than in-person services and was temporarily increased during the pandemic. “If reimbursement reverts to pre-COVID levels, some tele-ICU practices may not be as profitable,” suggests Dr. Davis. In addition, it can be challenging to practice tele-critical care across state lines, since providers must have state licensure in each state and privileges at each hospital where they provide services. “Some systems allow for privileges by proxy for a telemedicine program. For those exploring this initiative, make sure this is included as part of your services agreement,” he adds.
How patients & communities benefit
The greatest opportunity for tele-ICU benefit is in rural areas with low-density populations. Tele-ICU enables hospitals that don’t see enough volume to staff round-the-clock critical care physicians to provide life-saving care to patients with conditions like sepsis, pneumonia and overdoses. It also makes it possible for these hospitals to provide consultation in subspecialties like neurocritical care, surgical critical care, trauma and cardiac critical care.
Many studies show that, if implemented correctly, tele-ICU patients receive a higher level of care than they do with in-person care. “It is resulting in shorter length of stays, improved quality and lowered costs,” adds Dr. Davis.Share Email