NEHI offers best practices for tele-ICU's second phase

Tele-ICU appears to be entering a second phase marked by more diversity in practices and more experimentation. In response, the New England Healthcare Institute (NEHI) has issued best practices for making tele-ICU more scalable and accessible to more hospitals and more beds.

As of late 2012, there were 54 civilian and government tele-ICU monitoring centers in the U.S., it says, though MaineHealth in August announced that high costs had forced the Portland-based health system and its nine participating hospitals to drop the program.

New entrants to the market may provide competition among product developers and providers based on specialty offerings and alignment with other services such as telestroke, according to the announcement. So far, hospital executives have not had the time or knowledge to be informed buyers--especially with vendors keeping fee structures and coverage terms confidential--but more competition should bring more transparency to the market, NEHI says.

Among its recommendations:

  • Collect six months' worth of outcome data as a baseline before implementation: An effort that is challenging and costly but necessary to make adjustments for severity and track improvements.
  • Extend coverage to hospitals unaffiliated with the monitoring center: Most organizations cover only hospitals within their own network, but expanding to cover outside hospitals can help cover costs and solidify relationships and referral patterns with client hospitals. Working out the details, however, can take years involving negotiations over terms, protocols and roles.
  • Rotate clinicians through bedside and monitoring-center shifts: This can help eliminate an "us-versus-them" mentality between bedside and monitoring-center staff, improve clinical skills and broaden perspectives. The length of physical commute has been among the reasons hospital systems have not done this.
  • Extend coverage outside the ICU through wired beds and mobile carts: The capital costs of tele-ICU connectivity for a hospital (roughly $100,000 to $200,000) compares with a per-bed cost of ($7,000 to $12,000), so adding beds in other departments isn't overly cost-prohibitive. Such beds can help keep patients moved to a stepped-down level of care from returning to the ICU and emergency departments can hold patients waiting for an ICU bed.

Noting a number of hospitals that adopted tele-ICUs, but later dropped them, a New York Times article earlier this year questioned whether eICUs actually improve care for patients or the bottom line for hospitals.

A study that involved a small sample at Northside Medical Center in Youngstown, Ohio, found a slightly higher mortality rate and slightly longer length of stay after adopting tele-ICU at the 375-bed hospital.

To learn more:
- here's the announcement (.pdf)