The use of telemedicine in intensive care units (ICUs) is on the threshold of major change, with emerging best practices providing valuable precedents and guidelines for adopting tele-ICU care more broadly around the country, according to a new report by the national health policy institute, NEHI.
ICUs treat six million of the sickest and oldest patients every year, and the choices about how to manage ICUs carry high stakes: ICUs have both the highest mortality and the highest costs in healthcare, accounting for 4.1 percent of the nation’s $2.6 trillion in annual healthcare spending, or nearly $107 billion per year.
Many of the recent models of tele-ICU care reflect variations in practices that have the potential to make the technology more scalable and accessible in a variety of new settings including county, public, rural and critical access hospitals, according to the NEHI report, “Emerging Best Practices for Tele-ICU Care Nationally.” In the past few years, NEHI said, new product and provider options have emerged, as well as new efficiencies, which together are likely to drive broader adoption of these networks of audio-visual communication for monitoring ICU patients remotely.
NEHI identified six best practices that provide valuable data and experience for successfully implementing tele-ICUs more widely around the country:
• Establish pre-coverage benchmarks prior to tele-ICU implementation. By gathering baseline data six months before tele-ICU initiation, as John Muir Health did in California, executives can better assess where improvements have been achieved post tele-ICU and where more implementation work is needed.
• Expand coverage to hospitals unaffiliated with the monitoring center. A number of monitoring centers, including the University of Wisconsin Health and Christiana Care Health System, have used creative practices to support the care directed by clinicians in a different health system.
• Rotate clinicians through bedside and monitoring center shifts. This practice of rotating clinicians through both ICUs and the support centers limits opportunities for "us versus them" friction among staff, improves their clinical skills and broadens their perspectives.
• Cover critical access and rural hospitals. Tele-ICUs offer a potential solution to the lack of coverage for public and safety-net hospitals around the country, as Avera Health and Maine Medical Center have proven.
• Extend coverage outside of the ICU through wired beds and mobile carts. Using the tele-ICU monitoring center to extend coverage to seriously ill patients in other departments of the hospital and to post-discharge settings is an approach being used around the country to support both small, isolated hospitals and crowded urban hospitals.
• Make a business of "renting" tele-ICU coverage to hospital clients. Several vendors have pioneered using tele-ICU coverage as a contract service to third party hospitals and medical centers.
"The use of tele-ICU care is entering a second phase of adoption," NEHI president Wendy Everett said in a statement. “And as more tele-ICUs are implemented, the need for best practices to guide this expansion is critical."