The pulmonologist shortage is putting greater strain on our healthcare system than we could have ever imagined. As we rapidly launch new remote ICU programs across the country, let’s take the time to consider how telemedicine in the ICU answers the ongoing challenge to provide consistent coverage.
The physician shortage is compounded by new diseases and an aging patient population. Combined, these challenges and changes require new solutions to staff coverage and patient care, like telemedicine.
Inpatient hospital patients are different today
In an age when spine surgeries, angioplasties, hysterectomies, and other procedures are increasingly done on an outpatient basis, the profile of patients requiring inpatient hospital care is different from what it was 10 or even five years ago. Acute care patients are typically older and sicker today—and need intensive care at a rate that has reached a new national high. Consider these statistics from the Society of Critical Care Medicine:
- The number of critical care beds in the United States increased 15 percent in the past decade
- More than 5.7 million patients are admitted annually to ICUs in the United States
- Approximately 20 percent of acute care admissions are to an ICU
- Up to 58 percent of emergency department admissions result in an ICU admission
- All acute care hospitals have at least one ICU, and approximately 55,000 critically ill patients are cared for each day
And so, while hospitals set up clinics and develop new models of caring for a growing outpatient population, they also search for new ways to provide the more intensive care their inpatient population requires. That’s where telemedicine comes in.
Tackling the intensivist shortage
Because there is a national shortage of intensivists—physicians who are specially trained and certified in critical care—and because they are unevenly distributed across metropolitan and rural areas, many hospitals struggle to provide consistent ICU care.
It’s a problem for two main reasons:
- Research has shown that when ICU patients are cared for by intensivists who are available around the clock, good things happen: The Society of Critical Care Medicine reports that ICU costs and lengths of stay are reduced. Companion studies show that healthcare associated infections (HAIs) also drop, and ICU mortality decreases by 40 percent.
- The Leapfrog Group, a watchdog organization that grades hospitals on an annual survey of safety practices, asks hospitals to staff their ICUs with intensivists during daytime hours and provide timely responses to patients during off hours. (“Timely” means they must return pages within five minutes at least 95 percent of the time when not present on site or via telemedicine, and must arrange for a physician or other clinical staff to reach ICU patients within five minutes.)
Leapfrog’s recognition of Tele-ICU coverage
The latest results from Leapfrog’s 2015 survey, summarized in a 2016 Leapfrog report, indicate that fewer than half of hospitals meet this standard.
The good news is that telemedicine can help. Leapfrog recognizes Tele-ICU care for off-hours coverage. In addition, hospitals can earn partial credit by having intensivists available via telemedicine 24 hours per day, seven days per week, with onsite care planning done by an intensivist, hospitalist, anesthesiologist, or a physician trained in emergency medicine. With Leapfrog leading the charge for transparency into hospital safety practices and quality measures, this credit is important—a sort of “Good Housekeeping Seal of Approval” that can make a real difference in a facility’s community standing.
Perhaps even more important than Leapfrog recognition, Tele-ICU coverage can position hospitals to care for more acutely ill patients, and decrease the need to transfer them to tertiary referral centers. In doing so, it “levels the playing field” and keeps even the smallest rural hospitals able to provide the same valuable services to their communities as larger metropolitan hospitals. Tele-intensivists provide support to hospitalists and ICU nurses by being there with specialized expertise whenever they are needed. By the same token, they also provide value to community physicians who have privileges at their local hospitals.
How Eagle is different
ICU telemedicine can take one of two different approaches. One approach uses hardwired ICU beds that are connected to a “bunker” of computer screens that show alerts to doctors and nurses when a patient’s blood pressure drops, for example, or another significant change in condition is detected. Eagle operated one of those systems at one time, but we have evolved to provide the second predominant Tele-ICU model—where nurses “on the ground” monitor ICU patients and alert a team of intensivists working from their home office via videoconferencing technology to diagnose the patient and recommend treatment options.
It is certainly a more cost-effective approach than hardwiring every ICU bed to a system of detection technology. And it is more proactive, too. Tele-intensivists aren’t only available for emergencies, but they also can perform pre-emptive rounding—that is, rounding to spot potential problems before they occur. This is another advantage of deploying a model like ours. We’re flexible, too. If a hospital only wants Tele-ICU coverage on weekends, we can provide it. As we say to our hospital partners, “We don’t ask you to fit into our box. Just explain your box and we’ll fit into it.”
Inpatient metrics are critical
The adoption of Leapfrog’s ICU physician staffing standard has increased over time—from 30 percent in 2007 to 47 percent in 2015, but there is more work to be done. At Eagle, we stand ready to help hospitals adapt to changing standards and to the changing needs of patients. Sure, it might sound “sexy” for hospitals to offer new outpatient services to their communities, but inpatient volume remains critical, and prudent hospital providers and executives must be creative in maintaining it. Telemedicine—especially when deployed in critical care—is an efficient and cost-effective way to do so.