December 28, 2020
U.S. hospitals are facing a crisis and the end is still in question. With an increase in patient admissions and a decrease in staff, the COVID-19 pandemic is overwhelming hospitals across the country, even the largest facilities. The problem is as much of a staffing issue as it is bed capacity. During a COVID-19 surge, between 5 and 10 percent of a hospital’s workforce could be unavailable due to exposure and quarantining protocols. Many small hospitals in rural areas were already understaffed before COVID-19 and lack specialists capable of managing acute COVID-19 cases.
While non-COVID-19 admissions decreased dramatically due to fears of exposure, more than 19,000 patients are in intensive care units (ICU) due to COVID-19 on a given date in the U.S. The burden is forcing hospitals to divert and transfer patients to other facilities that have more capacity, delaying care to both COVID-19 patients and non-COVID-19 patients alike.
For patients with non-urgent medical needs and those who are stable, constant ICU care may not be a requirement. But the nature of an ICU is to provide immediate and continual care to patients with life-threatening cases and those who may soon be if they do not receive attention quickly due to staff shortages.
To speed care by extending staff capacity, hardest-hit hospitals and smaller, rural facilities who often have to transfer patients to see specialists many miles away are utilizing remote ICU telemedicine technology. Remote ICU telemedicine combines a telemedicine technology platform with off-site intensivists to give hospitals the ability to increase capacity, improve response times and decrease the need for patient transfers.
These remote critical care specialists have real-time access to patient monitors, test results, and audiovisual information to deliver care around the clock without ever stepping foot into the patient’s room. Remote ICU telemedicine also helps protect staff and non-COVID-19 patients from COVID-19 exposure.
A study that compared ICU telemedicine co-management methods and length of stay found that direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter length of stay outcomes than other strategies. ICU telemedicine connects hospitals of any size or location to remote intensivists and other specialists, such as pulmonologists and cardiologists, within minutes or even seconds.
Off-site providers can conduct ICU rounding and quickly respond to sudden changes in a patient’s condition, coordinating care with hospital staff and alerting them of urgent issues. They are also accessible for questions and consultations. Remote telespecialists are available 24/7/365, so there is never a problem with staffing. As hospital ICUs are able to provide faster, more responsive care with continual monitoring and rapid intervention, patients have fewer complications and recover faster with fewer instances of mortality.
One of the reasons patients experience a shorter stay in the ICU is due to the fact that they are able to be weaned off of a ventilator faster with the use of telespecialists. While ventilators save lives, they also introduce risk for infections and other serious complications. The longer a patient remains on a ventilator, the greater the risk of death.
Because off-site specialists have real-time access to accurate ventilation and sedation protocol data and are continually monitoring patients (something on-site providers are unable to do at the same capacity because of staffing shortages and caseloads), they are able to maintain optimal ventilator settings and alert staff when interventions are required. By applying remote ICU telemedicine technology, hospitals are bringing evidence-based practices to the bedside. Patients receive better care and hospitals are able to optimize their resources.
ICU telemedicine providers often partner with a pool or vetted remote specialists around the country who either want to expand their own practices or focus exclusively in telemedicine. Intensivists, for instance, are typically board certified in Critical Care Medicine and have a subspecialty certification in Surgery or Pulmonary Medicine. These qualifications are particularly helpful in treating COVID-19 patients, where breathing complications are common. Because these specialists are dispersed throughout the country and establish their own hours, hospitals can connect with any number of them instantly.
The ICU telemedicine platform is secure and HIPAA-compliant, and many integrate with hospital systems, such as the EMR, PACs, and scheduling, and provides both real-time audio and video communications capabilities. Wireless connectivity ensures users can transport the telemedicine carts from room to room or between hospital floors for optimal mobility.
The more cost-effective solutions allow hospital facilities to use existing HDMI-enabled television screens and computer monitors and include a speaker and microphone device with noise-cancelling capabilities. Telespecialists can connect from anywhere at any time via the web using any desktop computer or through an iOS app from their iPhone or iPad.
Once a hospital invests in and implements the remote ICU telemedicine platform, delivering care at scale is relatively simple, becoming standard protocol for the cases that lend themselves well to virtual visits and monitoring. Even as COVID-19 caseloads decrease and hospitals return to a sense of normalcy, telemedicine will help hospitals continue to optimize resources for the most efficient and best care delivery model possible.
Larger hospital systems that equip their satellite facilities with telemedicine capabilities can more closely connect with these smaller locations to deliver a higher level of care. Instead of rural facilities having to transfer patients to their parent hospital or other facilities because of a lack of resources, they are able to keep and care for more patients.
Remote ICU telemedicine brings cost benefits to hospitals, namely as a tool for optimizing staff utilization to deliver better care and outcomes at a lower cost and sharing providers with rural facilities. Combined with fewer hospital transfers and diversions, these savings help offset the initial capital outlay.
Patients also benefit, receiving faster, more responsive care closer to home. Even after the hospital discharges the patient, telemedicine provides a convenient channel for doctors to deliver follow-up care without patients having to return to the hospital or a clinic as they recover. With an improved hospital experience and outcomes, patients are more likely to remain loyal to the hospital system, further increasing the hospital’s reputation and patient base.
Hospitals have been leveraging ICU telemedicine for years, but never before has the technology proven as valuable as with the COVID-19 pandemic. As hospitals seek to expand their capacity and capabilities to deliver the best care possible during these challenging times, ICU telemedicine will continue to serve as a foundational tool that will persist post-COVID for long-term hospital and patient value.
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