By Melissa Wirkus Hagstrom, contributor
July 9, 2014 - Technology is no stranger to the intensive care unit, and the use of telemedicine in the ICU and other departments in the acute care setting seems to be growing, according to a May 2014 study published by The National Center for Biotechnology Information and the U.S. National Library of Medicine, National Institutes of Health.
The tele-ICU model of care, also known as remote or virtual intensive care units, is becoming a staple at facilities throughout the country, especially in rural areas where access to specialized care can be compromised. Such medical technology can come with a high price tag, but new research shows that you get what you pay for, and more, with tele-ICUs.
Stacie Deslich, MA, MS, health data analyst at West Virginia Medical Institute and co-author of the study, “Expanding Technology in the ICU: The Case for the Utilization of Telemedicine,” published in the May issue of Telemedicine and e-Health, found that tele-ICUs were cost effective, but the initial startup costs can be significant--as much as $100,000 per bed.
“The benefits of the utilization of this technology can offset those costs by reducing costs by 24 percent via decreased length of stay for patients,” she explained. “Once it’s up and running, it becomes cost effective because it increases safety, decreases medication errors and it allows many more patients to be treated from one centralized ICU.”
The study found that despite the significant upfront investment upfront, tele-ICUs are an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. The study was co-authored by Alberto Coustasse, Dr. PH, MPH, MD, MBA, associate professor of health care administration management at Marshall University Graduate College.
According to the American Association of Critical Care Nurses (AACN), there are approximately 800 to 1,200 tele-ICU RNs in the United States, and thousands of critical care nurses also interface with telemedicine personnel and processes on a daily basis. There are over 45 hospital systems that have tele-ICUs, and multiple hospitals and medical centers within those systems.
Theresa M. Davis, PhD, RN, NE-BC, has seen tremendous growth in critical care telemedicine over the last decade.
Theresa M. Davis, PhD, RN, NE-BC, clinical operations director at Inova Telemedicine enVision eICU, Inova Health System, has co-chaired AACN’s tele-ICU task force and served as a director in tele-ICUs since 2004. During the last decade, she has seen tremendous growth in critical care telemedicine.
“The way that tele-ICUs really work is that they drive collaboration across the critical care units and they ensure quality, safety and standardization of care,” Davis said. “The tele-ICU focuses on best practices principles and preventative care, which the ICUs are also doing at the same time, and it really enforces the work that is being done on the ground in the ICU.”
Leaders in the tele-ICU community are finding many additional benefits to this type of remote care. In addition to decreasing length of stay, telemedicine ICUs have led to a reduction in patient falls, more transplant identifications, and improved communication and collaboration--resulting in reduced costs and improved patient outcomes.
The increased use of telemedicine in ICUs is also creating new career opportunities for nurses, according to Davis and colleagues, bringing welcome relief to those who may be burned out by traditional bedside care.
“The other big trend that is happening now is that many sites are taking advantage of connecting their ICU to the emergency department. They are learning that if you connect those two departments together you can help in areas of admission, ICU consult, tele-disaster, trauma and pediatric consult,” Davis added. “Another trend is that the tele-ICU is becoming the foundation for tele-health models.”
Deslich and her colleague evaluated 55 case studies and literature sources for the qualitative study and their research supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. There is a huge group of patients that aren’t afforded the same care that you would get in a bigger city, and telemedicine opens the doors to better care for hundreds of thousands of patients without access.
“You are able to provide intensive care to patients who would never have received that sort of care because of their location,” Deslich said. “This decreases transportation costs and it decreases the cost of having to employ several intensivists across multiple units. It’s cost effective and efficient.”
Clinician buy-in is crucial to the success of telemedicine in the ICU--especially for patients who lived in rural areas and lacked access to traditional ICUs. Telemedicine opens the doors to better care for hundreds of thousands of patients without access. Deslich’s research showed that some of the tele-ICU units that did not have the support of physicians and nurses had high failure rates, and Davis agreed that support from leadership, physicians, nurses and other professionals and units on the care team is absolutely critical to telemedicine’s overall success.
“The key is that these tele-ICUs are most effective depending on how highly integrated they are with their ICUs,” Davis said. “The greatest challenge is the technology acceptance. When you look at peer review literature, it has shown that the more the tele-ICU has integrated into the critical care model, the greater and the more frequent you have patient interventions and communication.”
“High volume use has the most significant positive impact on patient outcomes--and really that is what this is all about,” Davis continued. “Positive patient outcomes will impact cost, satisfaction and morbidity and mortality. The benefits far outweigh any of the challenges we meet.”
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