The Emerging Crisis in the ICU from Advanced Healthcare Network

Results from telemedicine solutions drive broader adoption.

Across the country, there’s a growing crisis in intensive care units (ICUs). On average, patients admitted into the ICU suffer an estimated 1.7 potentially life-threatening errors each day. As a safety standard to avoid such scenarios, the Leapfrog Group advises that intensivist physicians (physicians specially trained in the care of critically ill patients) provide 24/7 ICU coverage. If this best practice were followed, the Group estimates that more than 54,000 ICU deaths each year could be avoided.

However, hospitals’ efforts to comply with the recommended standard of around-the-clock intensivist surveillance have run into a significant barrier – a serious national shortage of intensivists. With only about 7,000 practicing intensivists in the U.S. and more than 7,000 ICUs in the nation, the math translates to about one intensivist per ICU, clearly not enough for 24/7 coverage. According to The Journal of the American Medical Association, the intensivist shortage will become increasingly acute, with the supply meeting only 22 percent of the demand for services by 2020.

What does this mean for hospitals? ICU care is being delivered by already overburdened pulmonologists, surgeons and hospitalists. The strain of overseeing care for acutely ill patients with on-call demands, night and weekend emergencies, combined with other clinical demands, leads to burnout. Hospitals find it nearly impossible to ensure best practices are observed and that costly complications are avoided.

Tele-ICU & Technological Infrastructure
Within this challenging environment, the use of telemedicine in the ICU (also known as tele-ICU) is an emerging solution. A tele-ICU program provides the technological infrastructure to enable an intensivist-led team at a centralized location to electronically monitor patients around-the-clock, complementing the care plans of a hospital’s local critical care team. The team is available to deal with any changes in the patient’s condition.

Here’s what this new paradigm looks like in action:

  • A tele-ICU team of board-certified intensivists and experienced critical care nurses at a centralized location have access to real-time patient data, including vital signs, medications, lab results, and the patient’s entire medical history.
  • Each patient room is equipped with two-way video access which enables face-to-face consultations and interactions any time a medical situation demands action and the patient’s bedside physician is not present.
  • Patients are evaluated upon admission to the ICU by a tele-intensivist who proactively engages in their care.
  • Subsequently, the tele-ICU team assesses patients to ensure best practice compliance and engages in performing patient evaluations. Patients and families benefit from 24/7 access to an intensivist.
  • The software includes structured processes that constantly monitor the patients. Auto-alerts notify the tele-ICU team when a deteriorating situation arises. They can then work with hospital staff to ensure that issues are addressed immediately, before life-threatening and/or costly complications ensue.
  • Collaborative process improvement initiatives support a hospital’s treatment protocols and best practices, ensuring that quality standards are consistently applied for fewer complications and improved patient safety.
  • Acuity-adjusted ICU analytics supports benchmarking performance against national averages. Therefore, hospitals can work with their tele-ICU team to continually improve clinical, financial and efficiency metrics. For example, hospitals have reduced ventilator-associated pneumonia and sepsis cases, and improved glucose management.

In 2011, two major studies were released, one in The Journal of the American Medical Association and a second by the New England Healthcare Institute (NEHI) which confirm the positive contributions made by tele-ICU programs. The NEHI study found that with tele-ICU programs in place:

  • ICU mortality rates decreased 20+ percent
  • ICU length-of-stay decreased 30 percent
  • Hospitals gained significant volumes in ICU
  • Best practice compliance improved
  • Case margin improved 33-80 percent
  • Total margin increased 136 percent, including volume growth
  • Payers realized significant savings
  • Hospitals achieved payback within the first year

Other high-performing tele-ICU programs have also reported solid results in improving clinical outcomes, financial performance and operational efficiency. Advanced ICU Care has demonstrated in a large study of more than 10,000 ICU patients in a variety of hospitals settings that these hospitals on average achieved:

  • 40 percent reduction in mortality in the ICU
  • 25 percent reduction in ICU length of stay
  • 17 percent increase in ICU cases

Adoption of telemedicine in the ICU is increasing as evidence continues to demonstrate program effectiveness. In addition, the growing recognition that the ICU accounts for over 30 percent of hospital expenses drives the need to find meaningful solutions. The sustainability of the tele-ICU solution, in the face of staffing shortages, is promoting acceptance of and support for the tele-ICU concept by hospital leaders, other physicians and nursing staff.

This expansion is part of a national movement toward the adoption of telehealth solutions. Datamonitor reports that telehealth spending in the U.S. has increased more than 45 percent (compound annual growth rate) through 2012. BCC Research expects an 18 percent annual growth rate in the future. According to the NEHI report, tele-ICU installations in the U.S. have increased almost 15-fold since 2003.

The pressure of the aging population combined with the coming changes in healthcare payment will challenge hospitals to achieve optimal ICU performance. The push is already on for hospitals to improve efficiencies, hard-wire best practices and produce the metrics that demonstrate excellence in care delivery. In light of the intensivist shortage, tele-ICUs may hold the key to critically needed improvements in hospitals ICUs.

This article was originally published  by Mary Jo Gorman at Advanced Healthcare Network.