What Is a Tele-ICU and How Does It Work?
Partnerships between tele-ICUs and bedside teams elevate patient outcomes and care. Various frontline technologies enable this collaboration, and it can be a perfectly harmonious symphony when it works.
What is Tele-ICU?
Tele-ICU is an offsite command center with intensivists, critical care specialists in various fields, and critical care nurses. The critical care team treats patients 24/7 remotely through real-time audio, visual and electronic means. Like a bedside team, offsite TeleICU intensivists require full access to patient data. This method brings a TeleICU intensivist straight to the patient regardless of their location.
How Does it Work?
Tele-ICU works in various ways providing numerous benefits. For instance, a hospital that has adopted a Tele-ICU program can support its on-site ICU doctors by replacing or assisting them during graveyard shifts, thereby rendering them more competent and wakeful during the day.
Another more comprehensive benefit is that it enables the industry to address the disparity between ICUs and available board-certified intensivists in the US. This proficiency impacts ICU patient survival rates and the entire medical services ecosystem. For example, there are 6000 ICUs but only 5500 board-certified intensivists in the US.
Importantly, Tele-ICU can solve the lack of specialists at rural or remote hospitals with limited resources to hire full-time critical care experts who typically prefer to live in cities and work in big hospitals. It is also a powerful tool to enhance the capacity of hospitals in urban areas facing surges in traffic. According to US-based studies, as of 2010, less than 15 percent of
ICUs can provide intensivist care.
Dr. Benjamin Scott, a UCHealth Colorado anesthesiologist and chair-elect of the Society of Critical Care Medicine’s Tele-ICU Committee, says, “There’s always the risk that acuity or volume can outstrip your ability to care for all the patients in your hospital.” In tele-ICU settings, offsite clinicians and their bedside colleagues leverage expertise, advanced technology, and intensive collaboration to ensure that doesn’t occur.
More recently, by electronically providing aid and delivering real-time information to frontline clinicians, tele-ICU command centers have empowered busy hospitals during the COVID-19 pandemic by enabling caring for more patients while minimizing infection risk and using protective equipment.
Tele-ICU Use Case
Houston Methodist’s tele-ICU center supports 250 to 300 ICU beds across three of the group’s eight campuses. Bedside and operations center clinicians coordinate care with New York-based intensivists.
In patients’ rooms, the teams join forces via two-way audio and pan-tilt-zoom cameras. The camera provides a bird’s-eye view of each room, close enough for clinicians to see a pupil dilate or read a medicine bottle.
The operations center uses Lenovo PC workstations, Cisco phone systems, and Dell monitors, providing teams with a wealth of real-time data. Additionally, a Sickbay platform powered by Intel draws data from multiple sources. These sources include bedside monitoring, electronic health records, and biodata — to detect trends, evaluate risks and generate alerts.
When COVID-19 hit, mobile carts outfitted with iPad devices were implemented throughout the hospitals to allow remote teams to monitor patients entering the ICU and transfer them to another unit to prevent escalation to the ICU. Patients appreciated the human connection during a time of intense isolation.
By extending the resource, the carts enabled offsite teams to access COVID-19 patients waiting for ICU beds as fast as possible to improve outcomes. Overall, they served as a safety net when frontline staffers were overwhelmed.
Dr. Sarah Pletcher, Houston VP and virtual care executive medical director
“We could camera in and say, ‘Hello, we’re watching. You’re OK.’”
Sutter Health has relied on a tele-ICU setup for several years. Dr. Vanessa Walker, Sutter Valley Area, e-ICU medical director, expresses that “It is phenomenal how much you can learn about somebody through the cameras and utilizing the technologies available to us. I feel like I am in the room talking to the patient.”
Tele-ICU clinicians stress that their role is to enhance care, not replace bedside caregivers.
As Pletcher says, “If you build the relationships and that culture where everybody feels like they’re all part of the same team, whether they’re remote or at the bedside, that’s when you get the symphony.”
