Telemedicine Trends in the ICU: Best Practice Considerations

While intensive care units (ICUs) typically account for a mere 10 percent of hospital beds, they generate approximately 30 percent of hospital costs and cumulatively can account for 1 percent of U.S. gross domestic product (GDP). An essential part of the U.S. health continuum, ICUs treat 6 million of the highest-acuity patients annually and are characterized by the highest mortality rates and highest costs in the industry.

Quick response times and real-time interventions are critical components of improving ICU outcomes as well as reducing unsustainable healthcare costs. Yet, today’s ICUs are challenged by two converging trends: an increasing number and severity of critical care patients and a dwindling supply of critical care physicians.

In recent years, telemedicine techniques in the ICU have emerged as a promising strategy for addressing higher demand for services and the need for proactive intervention. The American Telemedicine Association (ATA) defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status.” In the ICU, these models often encompass use of audio, visual or combined audiovisual communication to remotely monitor a patient’s vital signs, physiological status, laboratory results and diagnostic tests. They also open up greater access to expert consultation with critical care practitioners that may not otherwise be available in a hospital setting.

The evidence backing the effectiveness of tele-ICU models is growing. A 2016 American Journal of Medicine article reported that approximately 11 percent of nonfederal adult ICU beds were supported by some form of tele-ICU coverage, also detailing the positive findings of 2011 and 2012 meta-analyses. The 2011 study found an association between tele-ICU and lower ICU mortality rates. Both ICU and hospital mortality decreased in the 2012 study, where findings also pointed to significant improvements in length of stay.

More recently, a 2017 study found that tele-ICU promoted increased case volume and access to high-quality critical care, reducing length of stay (LOS) and increasing profit margins. Another year-long 2017 study found that tele-ICU models helped cut LOS by a third, saving 26,000 ICU days across 17 hospitals.

The American Journal of Medicine article also points to numerous factors impacting the success of multimodality tele-ICU interventions including:

  • Thoughtful implementation strategies that are tailored to the coverage needs of specific hospital and ICU environments
  • Bedside provider buy-in and ongoing close integration between the tele-ICU and bedside teams
  • Inclusive rather than restrictive intervention permissions that promote timely response
  • Communication of suggestions and interventions to the different levels of the multidisciplinary bedside teams

Hospitals and health systems looking to implement tele-ICU can access the American Telemedicine Association’s updated guidelines for the effective, sustainable and safe use of telemedicine in intensive care units. Divided into administrative, clinical and technical sections, the document points to the need for strong leadership and a clear tele-ICU strategy as well as constant oversight of technology to ensure optimal use.

The American Association of Critical Care Nurses (AACN) has also established guidelines for tele-ICU programs that incorporate nurses in the delivery of care.

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