Tele-ICU companies, like Eagle, are responding to the physician shortage. The lack of critical care specialists, is straining hospitals across the country. An aging patient population, high-tech devices, and new diseases are compounding these challenges. This is certainly true for cardiovascular and pulmonary patients who require life-saving care, including those with COVID-19.
Many small rural hospitals have difficulty recruiting and retaining critical care specialists, often because there’s no vacation and weekend relief. This situation presents a serious challenge in providing consistent ICU care. Even metropolitan and suburban hospitals have difficulty keeping their ICUs fully staffed for these reasons.
Let’s examine the challenges hospital executives face in staffing their ICUs, and how telemedicine is the good news in this scenario.
Why is rural hospital staffing so difficult?
Physician shortages impact hospitals and patients across the country, but rural hospital staffing is even more difficult.
These hospitals depend on general practitioners, like hospitalists and nocturnist, to fill the gaps in specialist coverage.
The challenges of staffing an ICU
The very nature of critical care medicine requires highly focused and meticulous medical specialists, and the procedures they perform are literally life-saving. The most favorable outcomes for these patients are linked with high-intensity staffing, including a critical care specialist (an “intensivist”).
The intensivist has a pivotal role coordinating the patient’s care, and therefore must be competent not only in a broad range of conditions common among critically ill patients. These providers must also have experience with the technological procedures and devices used in intensive care settings.
Along with the intensivist, a pulmonologist is sometimes necessary for critical treatment. Nurse practitioners and physician assistants with critical care training also provide care in the ICU.
Telemedicine can help
Staffing an ICU with telemedicine professionals provides backup for intensivists, pulmonologists, advanced practitioners and nursing staff on nights, weekends and vacations.
By giving ICU physicians time-off, Tele-ICU services also help prevent physician burnout, which is typically higher than with physicians in other specialties. The highly stressful environment of the ICU — with long and irregular hours and end-of-life distress — results in a high rate of burnout, leading to posttraumatic stress disorder, suicidal ideation, and other serious psychological disorders.
Quantify Your ROI
How can a telemedicine program deliver additional revenue and enhance your facilities ROI? Financial benefits of Eagle’s telemedicine programs include:
- Reducing transfers
- Lower turnover and less physician burnout
- Eliminating locum support costs
- Cost Efficiencies through economies of scale
- Patient Satisfaction
- Reduced length of stay
Tele-ICU Companies Improve Patient Outcomes
Tele-ICU improves patient outcomes. The Society of Critical Care Medicine reports that using telemedicine reduces ICU costs and lengths of stay. Healthcare associated infections (HAIs) also drop, and ICU mortality decreases by 40 percent with Tele-ICU coverage.
Hutchinson Regional Medical Center in central Kansas found its ICU was facing increasing demands on performance due physician turnover. Replacing a critical care doctor or pulmonologist is challenging and expensive for rural hospitals. Hospital administrators realized that staffing challenges put both revenue and patient care at risk. Patients in rural areas are often transferred to distant referral centers. These transfers were reducing the hospital’s daily census and decreasing utilization of the facility’s 18-bed ICU and 23-bed pulmonology care unit.
Improving safety scores
Hospitals’ safety scores also improve based on ratings from The Leapfrog Group, a watchdog organization that grades hospitals on an annual survey of safety practices. Leapfrog 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. In addition, the hospital must arrange for a physician or other clinical staff to reach ICU patients within five minutes.
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.
How Tele-ICU companies boost revenue
Hospitals see significant savings by avoiding locum tenens costs for weekend, holiday and turnover coverage. Case studies also show that when hospitals bring telemedicine into the ICU, there is increased revenue with higher case volume, bed utilization and reduced transfers.
Meadows Regional, a rural Georgia hospital, found its ICU was facing increasing demands on performance due to:
- Growing patient acuity,
- Census surges during flu season and
- Frequent patient transfers to other hospitals.
It’s a story that underscores 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 — resulting in more open patient beds.
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.
After reviewing multiple Tele-ICU companies, Meadows chose Eagle. Now the hospital is able to care for ventilated patients in their hometown — increasing the hospitals daily census. At the same time, ventilated days per patient were down. It means the hospital is more efficiently weaning patients off ventilators and decreasing the average ICU length of stay — resulting in improved metrics and better utilization of the ICU.
ICU Telemedicine Provides Expert Care
With more than 5 million patients treated in ICUs each year and the increasing shortage of qualified ICU intensivists, our telemedicine program offers help to hospitals. Eagle Telemedicine’s offsite ICU intensivists:
- Reduce unnecessary transfers
- Increase patient volume
- Maximize ROI with incremental DRG reimbursement
Fewer transfers and readmissions
With Tele-ICU, transfers to tertiary referral centers are diminished. Tele-intensivists provide support to hospitalists and ICU nurses by offering specialized expertise as needed. TeleICU also reduces complications, which often lead to readmissions. Readmission rates for pulmonology patients is a key driver of Medicare penalties under The Hospital Readmissions Reduction Program (HRRP).
The program focuses on unplanned rehospitalization within 30 days for specific conditions including Chronic Obstructive Pulmonary Disease (COPD) and pneumonia. CMS also measures hospitals on readmissions for any reason to the same hospital or similar acute care hospital.
Tele-ICU programs have the potential to quickly recoup their implementation and operational costs.
Telemedicine in the ICU can take one of two different approaches. One approach uses hardwired ICU beds that connect 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.
However, Eagle has found (via experience) that another model is more effective — where nurses “on the ground” monitor ICU patients. The nursing staff alerts a team of intensivists working from their home offices via videoconferencing technology to diagnose the patient and recommend treatment options.
This is a more cost-effective approach to ICU management, and more proactive, too. Tele-intensivists aren’t only available for emergencies. These specialists perform pre-emptive rounding — that is, rounding to spot potential problems before they occur.
When deciding which of the Tele-ICU companies to select, there is another advantage of deploying the Eagle model. It’s flexible. A hospital can use Tele-ICU coverage only on weekends or at night. 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.”
Eagle Telemedicine provides a core team of telemedicine intensivists and pulmonologists to share ICU patient care management with onsite intensivists and/or hospitalists.
The Eagle team covers the night and weekend gaps in ICU staffing, performing proactive rounds with ICU nurses to assess, triage and institute early treatment in patients with an acute decline in their clinical status. Our telemedicine intensivists can run an ICU, handling everything from floor call to attending rapid responses and running codes.