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Telecritical care assists ICUs during a time of crisis

Healthcare leaders discuss their use of telecritical care programs to assist overburdened ICUs within their healthcare systems.

At the end of a night shift in March, William Beninati saw Intermountain Healthcare's telehealth volume skyrocket.

As the COVID-19 crisis hit, Beninati, a critical care physician, said Intermountain had to find ways to quickly reduce personal protective equipment use while also providing critical care assistance from nurses, providers and respiratory therapists at intensive care units (ICUs) across the healthcare system. One way the Salt Lake City-based healthcare organization decided to do that was to scale its telecritical care program, which is used to deliver critical care expertise remotely to ICUs in hospitals that may have limited resources.

During a talk at the American Telemedicine Association 2020 Virtual Annual Conference & Expo, Beninati and two other critical care physicians discussed why telecritical care programs were so impactful during the pandemic and provided tips on what CIOs should know about such programs.

Scaling telecritical care to meet COVID-19

Intermountain first implemented its telecritical care program five years ago to assist caregivers in emergency situations, particularly in rural hospitals within the healthcare system's network that didn't have an ICU, but still cared for critically injured patients.

The program operates out of a telehealth-enabled command center at Intermountain's flagship academic medical center in Salt Lake City. The command center includes clinical, patient access, technical support and operational support teams. The clinical team alone consists of 22 doctors and 20 nurses that serve 263 critical care beds in 12 facilities across Utah and Idaho.

William BeninatiWilliam Beninati

But when COVID-19 hit, Intermountain found the initial set up of its telecritical care program was limiting, as the telehealth software platform was restricted to its command center. Intermountain decided to quickly expand the program by loading the telehealth platform on workstations in all ICUs so bedside teams could have access to tools that helped limit traffic in and out of COVID-19 patient rooms, according to Beninati.

Additionally, the organization added respiratory therapists to its telecritical care team in response to the pandemic. "We had a baseline, mature telecritical care program that allowed us to make the changes we needed in response to COVID-19," he said.

Jeffrey GuyJeffrey Guy

Benefits of telecritical care

Jeffrey Guy, M.D., vice president of the clinical services group at HCA Healthcare in Nashville, Tenn., said, even before the pandemic, HCA Healthcare saw a need for additional ICU support within the organization's network, prompting it to consider telecritical care.

HCA Healthcare decided to focus its telecritical care program on increasing ICU capabilities at smaller facilities within the network and providing supplemental resources to overburdened ICU physicians, according to Guy.

HCA Healthcare partnered with Advanced ICU Care, a tele-ICU vendor, to deliver telecritical care services. Over a two-year period, the organization saw clinical and financial improvements, according to Guy. That included improved septic shock mortality rates, which dropped from 33% to 9%. In smaller facilities, the risk-adjusted mortality index, a metric that compares actual deaths to expected deaths, improved from a 1.2 mortality ratio, which means more patients died than expected, to a 0.4, which means fewer patients died than expected. Ventilator length-of-stay also improved by 44%, from 4.73 days to 2.63 days.

"We saw an improvement in care," Guy said. "The feedback from the surgeons and hospital executives was that telecritical care allowed them to take better care of their patients, keep more patients in their community and give a greater sense of capability to medical staff."

Sanjay SubramanianSanjay Subramanian

What CIOs need to know

Technology can make or break a telecritical care program, said Sanjay Subramanian, M.D., founding partner of telecritical care services vendor Omnicure.

Telecritical care programs are often implemented as a supplemental service for hospitals that may not have extensive ICUs. Before implementing a program, Subramanian said it's important to understand the healthcare organization's technology limitations and to conduct a readiness assessment to ensure the program can be successful.

Intermountain's Beninati described a platform's flexibility as crucial, enabling the technology to be used across specialties. He also said an ability to easily grow the program can be more impactful than investing in a product loaded with features.

"If you have lots of licensing fees that you add to this, it's really going to limit where you can go," he said. "A relatively stripped-down solution that can get to a large number of rural hospitals, in our judgment, is more valuable than top-tier, all-the-bells-and-whistles systems that put it out of the price range of the people you're trying to get this to."

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