He explains that remote intensivists are often good at being the “bug in the ear” for hospitalists, helping with treatment recommendations and asking, “Did you remember to … ?” While stabilizing a just-transferred ICU patient in a near-code situation, Dr. Bailey needed immediate access to the patient’s labs. An intensivist in St. Louis was able to look at the labs and recommend treatment.
Preliminary numbers at Saint Clare’s hint at a reduction of one day in ICU length of stay and two days for total hospitalization, notes Dr. Bailey. Figures like these can mean real savings in hospital costs.
Working together, hospitalists and remote intensivists can provide continuity of care as the patient is admitted through the emergency department and brought into the ICU, explains Dr. Bailey.
William D. Atchley Jr., MD, medical director for the Division of Hospital Medicine for Sentara Medical Group in Norfolk, Va., agrees with Dr. Bailey’s view. Dr. Atchley’s group also uses telemedicine technology for the remote care and monitoring of ICU patients. He is also a member of SHM’s Board of Directors.
“This is a true team effort, creating a seamless continuity from the emergency department to the ICU,” says Dr. Atchley. He cites septic shock patients as an example. He is able to start the septic shock protocols with the patient in the ED, and the intensivist will carry the protocols forward with the patient in the ICU. By morning, Dr. Atchley says he knows the patient has received the care needed, which frees him to care for other patients.
Sentara Healthcare, based in Norfolk, Va., was the first hospital system in the nation to implement VISICU’s technology, which allows hospitals to create a systemwide critical-care program. Using the VISICU eICU, the hospital or healthcare system provides the intensivists to staff the program, helping to leverage scarce clinical resources among the system’s ICUs.
Studies have shown that care by intensivists via telemedicine technology improves patient care and safety in the ICU. In a 2004 study, Sentara documented a 27% decrease in overall ICU and hospital mortality.2
Mobile Telemedicine
Advances in telemedicine technology have come a long way. Take remote robotic systems, for instance, which allow physicians to consult with patients, family members, and on-site caregivers while seated in their office, in another wing of the hospital, or at home.
InTouch Health, a Santa Barbara, Calif., company, uses about 100 robotic systems. While seated at a control station, equipped with video capabilities, a microphone, and a joystick, the physician can “drive” the robot into a patient’s room for consultation. The patient can see the doctor’s face on the monitor and—on the other end—the physician has access to patient data and can see the patient through a live video image.
The robotic system provides added ability for intensivists and other specialists to do another evening round on their patients, explains Tim Wright, vice president of strategic marketing for InTouch. A recent study shows that when physicians use robotic telepresence to make rounds in the ICU in response to nursing pages, physician response is significantly faster. Additionally, the study found a reduced length of stay, particularly for patients with subarachnoid hemorrhage and brain trauma, as well as an ICU cost savings of $1.1 million.3
The idea of robotic telepresence is similar to the telemedicine model of care being used in the ICU. Through the robotic system, an intensivist can log in and perform an evening round, updating hospitalists on new patients and issues that may have arisen.
“The beauty is that the intensivist and the hospitalist can be looking at everything together,” Wright says. “The intensivist can provide the specialist knowledge and training, while the hospitalist provides the ongoing care.”