It is common knowledge that the segment of the U.S. population aged 65 years and older is the fastest growing age cohort in our country. In fact, this group is expected to double in size within the next 25 years. This growth brings with it several hard truths:
- As the percentage of the population over 65 grows, the volume of medical conditions requiring treatment rises
- The increase in conditions to be treated will likely be accompanied by an increase in severity
- These twin conditions will drive escalation of intensive care unit (ICU) admissions, and therefore ICU utilization
These trends leave hospitals challenged to keep pace with the demand for critical care delivery and critical care specialists. Few hospitals will be exempt from looking outside traditional systems and methodologies to meet this burgeoning need for critical care service delivery. The emerging value-based, outcomes-centric healthcare landscape magnifies the challenge.
Industry estimates consistently suggest that hospital ICUs account for about ten percent of hospital beds, and typically generate over thirty percent of a hospital's costs. Industry experts further understand that an ICU's performance can greatly affect a hospital's marketplace reputation and its ability to support high-acuity service lines. Therefore, multiple factors combine to drive the inescapable conclusion that ICU performance is likely to have significant impact on hospital success and in some cases, viability.
Advanced technology within the ICU can play a role in helping improve patient outcomes, ease critical care staffing challenges and lower costs. Given the myriad of challenges facing hospitals in general, and the specific challenges ahead for ICU's specifically, a growing number of hospitals and hospital systems are evaluating (or experiencing) the clinical, operational and financial benefits of tele-ICU.
Regardless of a hospital's ICU staffing model, tele-ICU offers many healthcare facilities the ability to provide a new approach to specialized care for its ICU patients. Leveraging technology to connect the bedside ICU care team to critical care experts in centralized, state-of-the-art command centers extends the availability of intensivists, providing additional assurance that complex conditions can be more carefully and intensively assessed and treated.
A well-designed and well-implemented collaborative and integrated tele-ICU program also effectively enhances the productivity and reach of staff intensivists, other bedside clinicians, patient outcomes, and hospital ROI. Research indicates that financial benefits are derived from a combination of factors that include, but are not limited to, decreased length of stay (LOS), reduced staff turnover, higher case mix index (CMI) and larger patient volumes.
Making the case for tele-ICU
In March 2014, the journal CHEST published a study that is important not only because of its size and scope - 118,990 ICU patients, including a sizeable number of control patients – but also because it addresses best practices in patient management. This large scale, multi-site study is one demonstration of impressive clinical results. Across all participating sites, overall mortality rates declined by 13 percent and length of stay was reduced by 30 percent. One site reported that ICU mortality rates decreased more than 20 percent even as the severity of its patients' conditions rose significantly.
Consistent with any enabling technology, however, thoughtful consideration is required to achieve the full benefit of the service. A successful tele-ICU program combines advanced technology with high levels of clinical teamwork between bedside staff and remote critical care specialists. That collaboration is supported by the implementation of best practices and a joint commitment to enhancing patient outcomes.
A holistic approach to engagement is essential. Specifically, both sides of a tele-ICU partnership must demonstrate a clear understanding of the preliminary engagement steps, which include structuring positive clinical alliances with the critical care bedside teams. Obtaining bedside team buy-in and agreement on clinical best practices is the first – and arguably the most important – step in an effective tele-ICU program. The bedside team's needs, concerns, roles, and responsibilities must be addressed and incorporated into the operating plan.
Likewise, the proper implementation of tele-ICU technology is crucial to its effectiveness. Healthcare organizations should keep the following steps in mind:
1. Gain physician and staff support. In some instances, clinicians and staff are hesitant to adopt new workflows or processes. Therefore, strong executive physician leadership and support for a tele-ICU program is necessary. In addition, experienced tele-ICU partners should understand how to lead conversations about structuring clinical collaboration and tele-ICU integration. When bedside teams proactively join with remote teams to define roles, protocols and responsibilities, staff acceptance tends to be high.
2. Leverage existing technology. Most of the technology integration required for remote patient monitoring can be provided by tele-ICU partners. Based on involvement with the many different hospital IT systems, a tele-ICU partner's technical expertise can dramatically ease the workload of busy hospital IT departments. The ability to efficiently integrate new technologies with existing systems while minimizing IT disruption is a key factor in tele-ICU success.
3. Employ data-driven outcomes reporting. A tele-services provider must be able to offer current, real-world data based on its relationships with a range of hospital partners. The most sophisticated tele-ICU vendors use industry standard algorithms to measure and monitor patient acuity and outcomes in conjunction with expert clinical staffing. This allows them to provide detailed and objective reporting on patient progress to the bedside teams they support.
The future of tele-ICU
Tele-services are consistent with the demands of today's healthcare marketplace to implement tools and services that assist hospitals in improving outcomes and establishing best practices protocols while concurrently generating a tangible and positive return on investment. Tele-ICU partners have built the clinical expertise and capacity and the technology infrastructure to create successful tele-ICU partnerships that benefit patients, families and hospitals.
These partnerships use expert service delivery to leverage scarce clinical resources over an expanding market need. As the U.S. population ages and ICU utilization increases, the enlightened use of tele-ICU can meet the growing need for critical care specialists. Furthermore, this solution supports emerging value-based care delivery models that focus on improved patient outcomes, lowered costs and higher quality of care. With a robust tele-ICU approach, hospitals can effectively "extend the care clock" to 24/7 – leading to better financial outcomes for hospitals and better care for patients during their ICU stays.
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1 Halpern NA, Bettes L, Greenstein R: Federal and nationwide intensive care units and healthcare costs: 1986–1992. Crit Care Med 1994; 22:2001–2007.
2 New England Healthcare Institute (NEHI) and the Massachusetts Technology Collaborative. Critical Care, Critical Choices: The Case for Tele- ICUs in Intensive Care. 2010.
3 Lilly, C and University of Massachusetts Memorial Critical Care Operation Group: A Multi-Center Study of ICU Telemedicine Reengineering of Adult Critical Care: CHEST 2014; 125:1518-1521.
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