An Alternative Approach to 24/7 ICU Coverage

During the day, Dr. Brath is able to handle the majority of management tasks involving patients and their families, answering questions, developing plans of care, and speaking with physicians, Taylor says. At the same time, data is being continuously fed to the tele-ICU monitoring center in St. Louis, which is manned by intensivist at all times. If Dr. Brath is tied up with another emergency or needs assistance with another patient who is beginning to deteriorate, he can get immediate access to the intensivist in St. Louis. 

The intensivists at both locations, on-site and off-site, can communicate via audio and high-resolution video. “The intensivist in St. Louis has a bank of computer screens and can bring up the ventilator setting, the heart rate, medications, problem lists, vital signs, nurses’ and physicians’ notes—whatever they need they have instantaneously in front of them,” Taylor says. 

The tele-ICU monitoring center takes over primary management of the hospital’s ICU between 7 p.m. and 7 a.m., Taylor says. “During the nighttime hours, if there is a change in ventilator settings or if there is low potassium or a change in blood pressure, that dialog and the patient management comes from St. Louis,” Taylor says. He notes that that the tele-ICU monitoring software is capable of early detection of a change in the status of the patient. “The software is so sensitive that it frequently picks up things before the clinical staff at the patient’s bedside has even noticed,” he says. According to Taylor, the hospital’s ICU typically averages 40 phone calls with the tele-monitoring center in St. Louis during a 24-hour period. Most of those calls take place at night. 

One thing that the off-site intensivist can’t do is an intervention, Taylor says. For that, the hospital maintains a hospitalist and anesthesiologist in-house, and the intensivist and/or pulmonologist are on call. During the day, Dr. Brath works with a physician assistant as well as a team of specialists, Taylor says. 

High Point Regional has a total of 20 beds that are monitored remotely: eight in its medical ICU; eight in its intermediate ICU; and two in its surgical ICU, which is the hospital’s open heart unit; and two in its critical care unit. It also has two remote units that can be deployed anywhere in the hospital; one on the floor with the critical care beds and the other in the ED. 

Overall, how does the tele-ICU system stack up? Over one quarter, High Point Regional saved over 200 patient days, which resulted in significant cost savings, Taylor says. “It would be wonderful if we had 24/7 intensivists, but our volumes are not sufficient to support that, and nationally there are not enough intensivists and critical care physicians to cover all of the critical care beds,” he says, adding that the tele-ICU system is the next best thing.