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Cover Story: ER/ICU Management Tele-ICU comes of age

Studies, hospital fi ve-year results validate effectiveness of the technology. By Mary Jo Gorman, M.D.


he promise of telemedicine has been the next big thing in healthcare for some years now. Over the past fi ve years, the application of telemedicine in the ICU – known as tele-ICU – has become one

of the fi rst telehealth initiatives to prove itself in medical care as a broad solution offering continuous patient manage- ment and oversight, which works for hospitals of all sizes throughout the U.S.

And it’s just in time. Eleven years ago, the Leapfrog Group identifi ed 24/7 intensivist staffi ng as one of its safety standards for the ICU, estimating that more than 54,000 ICU deaths a year could be avoided if this best practice was implemented in U.S. hospitals. However, due to a severe shortage of intensivist physicians, hospitals have found that it’s almost impossible to provide the recommended level of intensivist coverage. In fact, less than 20 percent of hospitals have intensivists providing around-the-clock

Mary Jo Gorman is CEO and founder of Advanced ICU Care. For more on Advanced ICU Care solutions:

coverage. The serious shortage of those with specialized training in critical-care medicine, combined with the aging of our population, is driving a crisis in the ICU that needs immediate attention. Yet many hospitals have not yet responded to this alarming trend. The ICU is a diffi cult area of the hospital to manage well for two major reasons. The fi rst is a lack of analytical tools in the ICU for administrators to measure the performance of the ICU. ICUs usually account for 10 percent of the beds in the hospital, yet generate 30 percent of the costs. The ICU can be a bottleneck to the ED and the OR and can seriously impact the ability of the hospital to throughput new cases, resulting in loss of revenue. But if these factors aren’t measured, hospital management may have no idea of the magnitude of the problem. Secondly, for too long, ICU management has been confused with ICU staffi ng. Obtaining the necessary staff members is an expensive, multi-year project that distracts from the implementation of best practices, training and performance. However, two recent events are changing this scenario and bringing tele-ICUs to the tipping point of universal acceptance. The fi rst was the publication in 2011 of two major studies (one in the Journal of the American Medical Association and the second by the New England Health Institute) that con-

8 December 2011

fi rm the positive contributions made by the tele-ICU. The NEHI study found that with tele-ICU programs in place: • ICU mortality rates decreased 20+ percent; • ICU length-of-stay decreased 30 percent; • Hospitals gained signifi cant volumes in ICU; • Best practice compliance improved; • Case margin improved 33-80 percent; • Total margin increased 136 percent, considering volume growth;

• Payers realized signifi cant savings; and • Hospitals achieved payback within the fi rst year. The second key event is the experience of the early adopters of tele-ICUs, which began about fi ve years ago. The hospitals that implemented robust ICU-management programs with their 24/7 telemedicine programs can report solid results in improvements in clinical outcomes, fi nancial performance, operational effi ciency and acceptance of this concept by the medical staff and the nursing staff. The pen- etration rate of comprehensive 24/7 telemedicine programs for use in the ICU is almost 10 percent.

Hospital’s fi ve-year results validate technology When it opened its doors a little more than fi ve years ago, Ministry Saint Clare Hospital in Wisconsin became one of the fi rst hospitals in the U.S. to implement a tele-ICU unit. During the planning stages for the new facility, the hospital intended to recruit intensivists to staff the ICU so that they would meet the Leapfrog Group’s guidelines to have physicians trained in critical-care medicine, monitoring ICU patients 24/7. However, they found – as have so many other hospitals – that attracting intensivists was a diffi cult and often fruitless undertaking.

Searching for alternatives, they evaluated and selected a program offered by St. Louis-based Advanced ICU Care, which is now the largest independent provider of tele-ICU programs in the U.S. Their program combined the three ele- ments essential to meeting recommended ICU standards: • A remote monitoring center with real-time access to all patients’ clinical data such as lab results, medical records, vital signs, video communication in patient rooms and automated alerts that notifi ed clinicians immediately of any event or reading that needed immediate attention.

• A highly trained and experienced team of intensivist physicians and critical-care nurses available to monitor patients around the clock, able to act immediately when a patient’s condition changed and before the situation


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