With the rapid adoption of telehealth programs around the U.S., critics complain that there's simply too little research and hard data on its efficacy. But with physician shortages continuing, and few hospitals able to provide 24/7 physician coverage of their ICUs, the pressure to adopt telehealth measures continues to grow.
FierceMobileHealthcare sat down with Larry Hegland, CMO at Westin, Wisc.-based Ministry Saint Clare Hospital, to get an early look at the results from his tele-ICU program, which has provided round-the-clock physician staffing (on-site and remote) for nearly six years. We also caught up with Mary Jo Gorman, CEO of the hospital's tele-ICU vendor, Advanced ICU, just days before they published a case study on the facility's experiences.
Two big positive results have been lower ICU lengths of stay and fewer readmissions. Ministry ICU patients spend only 1.76 days in the ICU out of an average 5.23-day hospital stay, Hegland reports. He adds that the program also has brought the hospital's readmission rate 10 to 15 percent below the national average for hospitals of its size.
Tele-ICU also can increase the number of ICU cases, and reduce mortality, according to a recent 10,000-patient study conducted by Advanced ICU. Studying four client hospitals with six ICUs between them, Advanced ICU found mortality rates fell by 40 percent, lengths of stay dropped by 25 percent and ICU cases increased by 17 percent after one year of implementing tele-ICU programs, according to Gorman.
Ministry's program works as a mix of direct clinician-to-clinician video-conferencing and remote patient monitoring. At Ministry, patients are wired with sensors connected to blood pressure cuffs, IV monitors, pulse oximeters, arterial pressure lines, ventilators and other devices. Advanced ICU clinicians--including physicians, nurses and nurse practitioners--monitor the data feeds and track for possible exacerbations, notifying on-site providers when they see something going awry, Hegland explains.
Nurses at Ministry also can video-conference with Advanced's central clinical office to discuss any on-site problems or questions if a patient's regular doctor isn't available, Gorman adds. The program has completely changed the care paradigm, according to Hegland.
The traditional ICU has a "sunrise to sunset" culture, with most procedures and treatment changes--such as medication adjustments or extubations for ventilator patients--taking place during the day, Gorman says. That's when physicians feel best able to manage any crises that arise, she explains. Evenings, weekends and holidays largely are spent maintaining patients, without much active treatment.
With tele-ICU, "we don't do nighttime babysitting. We are actively managing patients 24 hours a day," Hegland says. Remote physicians now monitor patient vital signs day and night, and can initiate procedures such as an extubation--with a physician on video-conference guiding a local respiratory therapist, for example--at night or on a weekend, if that's when the patient is ready, Hegland says.
The ICU remote monitoring, much like at-home remote monitoring systems, also can catch exacerbations hours or even days before they present fully, Gorman says. "You have fewer crises. We're able to see minor changes before a patient stops breathing, have them intubated and on a ventilator, avoiding the final crisis," she says.
Tele-ICU is an IT-heavy endeavor, however. When Ministry opened in 2005, it needed a fully dedicated T1 line to support the constant data flow. In more recent years, they've switched to a secure Internet VPN, but the program is definitely a bandwidth hog.
It also can be a challenge for some on-site physicians to learn to work with the Advanced ICU team, Hegland notes. The telehealth clinicians tend to work in a highly standard, protocol-driven way that can be a bit uncomfortable at first for physicians who are more used to less-structured encounters.
A tele-ICU program also works best for hospitals that have at least one on-site ICU specialist, who monitors patients in person, and communicates with the remote team, he adds. The program can work without it, for hospitals that simply don't have the specialty staff, but there are cases where seeing and touching patients reveals more about their condition than a sensor or monitor.
Tele-ICU hospitals also have to create iron-clad disaster plans, to ensure coverage in case of a power outage, weather crisis, or the like. In the few cases where Ministry had a network outage, the system switched to the telephone system, with onsite clinicians monitoring patients and calling their results in to the central Advanced ICU team, and getting clinical guidance by phone.
To learn more:
- get more detail from Ministry's case study in Health Management Technology