Best Telemedicine in the ICU Boosts Census and Leapfrog Scores

Telemedicine’s value to hospitals is demonstrated every day. In Emergency Departments (EDs), where stroke patients get the timely treatment they need in their local community hospitals without having to be transferred to a distant referral hospital. On the floor, where rounding stays on a timely schedule. In the boardroom, where examples of patient and staff satisfaction, as well as bottom-line benefits, are frequently heard.

The ICU is another area where telemedicine is significantly changing how healthcare is delivered―for the better.

Case in point: A rural Georgia hospital with an ICU that was facing increasing demands on performance; growing patient acuity; census surges during flu season; and frequent patient transfers to other hospitals. It’s a story worth sharing because it’s a good example of how quickly telemedicine can make the difference between an ICU that bends under pressure, or one that gains new strength and stability to face tough new demands.

Meadows Regional: an ICU tele-success

Like many hospitals today, Meadows Regional Medical Center, a 57-bed hospital in Vidalia, Ga., is seeing the effects of our nation’s elderly population growth firsthand. That growth—extensively documented by statistics like those showing the number of people aged 75 and older will rise by 73 percent by 2030—is driving the need for more medical services and more doctors that we simply don’t have now, and won’t have in 2030. (The predicted shortfall of specialty physicians is expected to be between 33,500 and 61,800, according to the Association of American Medical Colleges.)

It’s a fact that Meadows Regional understands all too well. At Meadows, patient acuity in the facility’s eight-bed ICU had steadily increased in recent years. More patients needed ventilators and were staying on them longer. In addition, high utilization during flu season often resulted in as many as five to six patients on ventilators in the ICU; the average had been one to three.

While two pulmonary intensivists managed care for ventilated patients on weekdays and each covered one weekend per month, two weekends a month were left uncovered. As a result, Meadows Regional was transferring patients frequently to tertiary facilities in Savannah and Macon—90 miles away—or Augusta—100 miles away. In addition, the lack of coverage had resulted in a “C” safety grade from Leapfrog. Something needed to be done.

Meadows Regional chose Eagle Telemedicine to provide a core team of tele-intensivists to share ICU patient care management with onsite intensivists and hospitalists. The team covers night and weekend gaps in ICU staffing, shares patient care management with the onsite team, and is available to assist with patient diagnosis and treatment.

Keeping more patients and other strong results

After the first nine months of the program, results are strong. The increase in ventilator days from 44.3 to 49.6 is a clear measure that the hospital is keeping more ventilated patients in their hometown hospital. At the same time, ventilated days per patient are down. It means the hospital is more efficiently weening patients off ventilators, helping decrease risk factors such as ventilator-associated pneumonia. This is measured by the decrease in average ICU length of stay (ALOS) from 4.7 to 4.5.

In addition, though previously Meadows Regional was not hitting some its marks in Leapfrog ICU quality measures, they are now. Eagle Telemedicine helps the hospital fulfill the standards for intensivist coverage in the ICU. In 2017, the hospital’s Leapfrog score was “C.” With the tele-ICU program in place, the hospital achieved an “A” rating in just a year’s time. Throughput is better, too. As more patients have their acuity level downgraded and are transferred to a standard inpatient care bed, the hospital has an opportunity to open ICU beds earlier, helping maintain optimum census levels and relieving overload in the ED.

Tele-intensivists are easy to work with

You can read more details about Meadows’ success in a full case study, but I would like to close by sharing what the hospital’s Chief Medical Officer, Karen McColl, MD, has to say about her experience with Eagle.

She says she and her team like the fact that they aren’t dealing with “20 intensivists and seeing a different one each time we sign on.” Eagle assigned a small core team of intensivists to serve Meadows Regional, so the facility sees three or four physicians regularly, and quickly developed a close bond with them.

Dr. McColl praises the way the tele-intensivists communicate with patients and staff, as well. One example: These physicians are adept at using the technology to move the monitor screen so that they face each person—patients, family member, staff—as they talk with them. Little things like this make a big difference in helping everyone feel comfortable with telemedicine.

From the outset, she liked the fact that Eagle Telemedicine is led by physicians, and understands the issues doctors must deal with every day. In short, she feels she can talk to us on a peer level, and finds us easy to work with. We’ve known all along that these are our core strengths. And while Eagle Telemedicine continues to grow, add new services and form new partnerships, these things will never change.