The growing acceptance of telemedicine has helped it gain ground in areas never imagined like emergency rooms in rural areas in the Midwest and to quickly identify stroke patients. In recent years the shortage of intensivist physicians has spurred the growth of eICUs, a system in which healthcare professionals work remotely to provide supplemental ICU coverage when it’s needed most.
Geisinger Health System has built a reputation for taking innovative approaches to medicine from its research to improve adherence to its patient-centered medical home model Proven Health Navigator for patients with chronic conditions to improve coordinated care.
Susan Fetterman, a vice president in the division of medicine at Geisinger Medical Center in Danville, Pennsylvania works with the eICU program which uses technology developed by Philips Healthcare. Philips’ patient monitoring system, originally developed more than 10 years ago, is used by 400 hospitals, according to a statement from the medical device company.
But an article authored by Fetterman and three Geisinger colleagues in the American Association of Critical Care Nurses contends that misconceptions about what “tele ICU” can and can’t do for providers are hindering its expansion in other providers.
In an interview with MedCity News, Fetterman talked about Geisinger’s tele-ICU program, which it implemented in 2010 and how it can help advance the Accountable Care model by using technology to improve the quality of care for patient populations.
How it works For the uninitiated, a tele-ICU team works remotely with a hospital’s bedside ICU staff to provide care, either on a daily basis or to cover the overnight shift. It monitors patient vital signs data for trends and can alert bedside staff if there’s a sudden decline in the patient’s condition. With its eICU system, the staff can communicate directly with patients through a two-way video screen and two-way audio channel. The tele-ICU team member is identified on the video screen. The video can give the tele-ICU team a clear picture of the patient, down to their eyelashes. Although it can track data from many patients simultaneously, it can only make video contact with one room at a time.
It can help address intensivist shortage The decline in the number of medical school students opting to go into internal medicine plus the two years training they would need in pulmonology makes tele-ICUs a viable option for hospitals that might otherwise struggle. In addition to using the eICU program in its own health system, Geisinger is working with neighboring Schuylkill Health System to help with overnight ICU coverage. A tele-ICU team can monitor as many as 60 patients at one time depending on the need. But in addition to addressing the intensivist shortage, it can also help hospitals identify nursing and support staff gaps so healthcare professionals can focus on patients.
Provides an extra set of eyes and ears to improve patient care. One of the misconceptions that has hindered the growth of tele-ICUs is that they are designed to spy on bedside staff. Fetterman admits it can take some time for bedside ICU staff and the tele-ICU team to find the best way to work together. But once communication kinks are ironed out, the two teams form an important partnership. A member of the tele-ICU team might notice an irregularity in a patient’s vitals and alert a member of the bedside team to check the patient out, for example. Smaller institutions in the Geisinger Health System are using the eICU system in cart form.
Improving quality of care Fetterman points out that mortality rates have improved at healthcare systems that have implemented tele-ICUs and length of stays have also come down. By using data driven information for improving care, hospitals are changing how they’re caring for patient populations.