The Telehospitalist
The patient was in the ICU at Saint Clare’s Hospital in Wausau, Wis. An intensivist from St. Louis who had been caring for her remotely through telemedicine technology was helping clinicians manage the end-of-life issue for her and her family.
Subjects like this can be difficult for hospitalists, who may not have as much experience with the protocols involved in end-of-life care. But at Saint Clare’s, which offers remote care and monitoring by intensivists and critical-care nurses through an eICU program, critical-care specialists are there to provide continuous care to the hospital’s sickest patients, as well as support for the onsite clinicians in any number of situations involving ICU patient care.
Dellice Dickhaus, MD, medical director for Advanced ICU Care and a practicing intensivist, helps provide remote care around the clock for patients in Saint Clare’s ICU. Advanced ICU Care’s board-certified intensivists and critical-care nurses remotely care for and monitor patients in multiple sites from their operations center, more than 400 miles away in St. Louis. They use telemedicine technology developed by Baltimore, Md., firm VISICU that combines clinical management software with real-time video feeds and patient data, such as labs, vital signs and medications.
In the case of the critically ill patient, while the hospitalist was driving the patient’s care program and taking care of many of the daily issues, Dr. Dickhaus helped manage the end-of-life issue. She was available at the push of a button to talk with relatives and provide information they needed to make decisions about their family member’s care. She discussed the patient’s prognosis and options with the family, and kept the hospitalist on staff apprised of the conversations.
Because Dr. Dickhaus and other clinicians at Advanced ICU Care had been helping manage the patient’s care in the ICU, the patient’s family gained confidence in the remote intensivists, says Dr. Dickhaus.
Demands of an Aging Population
The aging of America will have a tremendous effect on healthcare, particularly regarding care of the critically ill and in managing such areas as pulmonary disease. Consider that more than half of all ICU stays are incurred by patients older than 65. Further, patients older than 65 account for more than two-thirds of all inpatient pulmonary days.
What does this mean for hospitalists? For one, the aging population will create a demand for care that is projected to outpace the supply of intensivists and pulmonologists.1 With fewer of these specialists, hospitalists may be compelled to take on more responsibilities with critically ill patients, leaving less time for other patients. The expectation of healthcare services provided will likely change, possibly growing in scope and complexity. The time it will take to deliver care is also expected to rise. All these are reasons for the growth in telemedicine technologies, with many designed to improve patient care by delivering limited resources where they are needed most.
Continuity of Care
Richard Bailey, MD, medical director of Inpatient Care and Hospitalist Services at Saint Clare’s, says having remote intensivists lets his staff focus on hospital patients outside the ICU.
“One critical patient can tie you up for hours,” Dr. Bailey says. “Advanced ICU Care’s intensivists are hands-on physicians, helping us round on ICU patients, take patient notes, and handle first-line phone calls.”
There is no difference, he says, between having intensivists in St. Louis, for example, versus on-site. “They are more than a microphone and a camera in the ceiling; they are members of our staff,” he says. “We trust them to take care of our patients.”
