Improving ICU Care in Small and Rural Hospitals Through Virtual Rounding

Intensive care units (ICUs) provide lifesaving care for the most critically ill patients. However, many small to medium-sized hospitals and rural hospitals face challenges in providing high-quality 24/7 intensive care due to limited resources and staffing shortages.
Virtual ICUs (vICUs), where off-site intensivists use audiovisual technology to participate in bedside rounds and assist onsite staff, are emerging as a solution to improve care in these settings.

A Looming Public Health Crisis.

The growing shortage of qualified physicians in the United States is sparking a looming public health crisis to the tune of an estimated shortage of up to 124,000 physicians across all specialties by 2034. Critical care physicians are expected to be in particularly short supply, with an expected deficit of between 10,300 and 35,600 physicians over the coming decade. ICUs with intensivists in constant attendance are proven to have better clinical outcomes than those where intensivists are not in 24/7 attendance, but fewer than 15% of US hospitals have dedicated physicians in the ICU. 

The use of tele-ICU services has grown rapidly in recent years as hospitals seek ways to leverage technology to improve care quality and patient outcomes. Tele-ICUs allow offsite critical care teams to monitor ICU patients remotely using audio, video, and data feeds. This enables round-the-clock coverage and early intervention when patients show signs of deterioration.

When implementing a tele-ICU program, hospitals must decide whether they want to implement a proactive or reactive approach to patient management.

With a proactive tele-ICU, the remote critical care team takes a hands-on role in patient care, making recommendations and intervening at the first sign of decline. They analyze real-time data to anticipate problems and suggest preventive therapies to the bedside team. The goal is to get ahead of complications and avoid adverse events.

Reactive tele-ICU model

In a reactive tele-ICU model, the offsite team acts more as a safety net, intervening only after a patient has started to deteriorate. They offer support upon request but otherwise let the bedside ICU staff direct care. This approach aims to leverage technology to identify emergencies and urgent needs.

Tele-ICUs enable intensivists and other critical care professionals to leverage technology to improve access and quality of care for the critically ill. However, to realize the full benefits, hospitals must optimize their tele-ICU workflows to promote effective and timely interventions.

Implementing a telemedicine program may seem like a costly endeavor, but it doesn’t have to break the bank. This comprehensive guide provides hospital administrators and decision-makers with budget-friendly, actionable tips for rolling out cost-effective telehealth services.

Learn how to make the most of your existing video conferencing technology and equipment to pilot services instead of purchasing expensive new tools. Start with a small pilot program focused on one specialty area and gather learnings before expanding more widely.

Leverage remote provider staffing models to access top talent rather than hiring full-time staff early on. Take advantage of available government grants, nonprofit funding, and other subsidies to offset training and implementation expenses.

And partner strategically with experienced health organizations who can provide insights into best practices and help avoid missteps. Follow these and other evidence-based recommendations to implement telemedicine in affordable stages, maximize resources, and work towards financial sustainability.

The tips outlined in this guide will allow you to provide patients with the proven benefits of telemedicine access in a prudent, cost-effective manner tailored to limited budgets. Telemedicine is the future of healthcare delivery and this step-by-step playbook will walk you through making it a reality at your hospital through tactical spending, resource utilization, and operational efficiency.

Each year, more than five million patients are admitted to intensive care units (ICU) across the United States. As the number of patients requiring ICU admission increases, hospitals are facing a shortage of staff with the correct qualifications to provide high-quality care. Studies have shown that intensivist-led ICUs have better outcomes than those staffed by doctors who are not specialized in the management of critically ill patients. But finding these highly trained staff – especially in rural or less populous areas – is often enormously challenging.

What is Teleneurology?
Neurology is just one of many fields of medicine that is taking advantage of advances in telemedicine which make it possible for doctors to see, diagnose and treat patients remotely. Using fairly simple equipment like a tv monitor or tablet combined with more powerful communication technologies, providers, including neurologists, can assess a patient whether s/he is at home, in the hospital, or in a medical clinic. With telehealth technology, remote providers can monitor patients’ blood pressure and other vitals in real time and access the health data they need to make diagnoses and treatment decisions.

Telestroke technology is a form of telemedicine, where stroke specialists provide real-time consultations and guidance to bedside providers who are managing stroke patients in a hospital or medical center that does not have stroke specialists on site, using telemedicine technology. The technology enables ER physicians or other emergency department personnel to have near-instant access to the expertise they need to arrive at the correct diagnosis, make appropriate critical decisions, and provide timely treatment.

This can lead to prompt and accurate diagnosis and treatment, which translates to a much greater chance of full recovery for patients. However, the implementation of a telestroke system also poses challenges such as reimbursement, licensing, infrastructure, and buy-in and training. Despite the challenges, telestroke technology has the potential to save lives and improve patient recovery from strokes.

Over 5 million patients are admitted to the ICU every year in the United States. Of these, the average patient stays in the ICU for around 3.8 days, depending on the nature and severity of his or her condition. As no one wants to spend time in the hospital, least of all in a critical care ward, it is important to ensure that the patient experience is as comfortable and positive as possible.

Whether you are an on-site critical care physician or are considering becoming employed by a TeleICU, the rise of this particular branch of telemedicine is great news. The US, among other countries, is experiencing a shortage of medical professionals, including ICU physicians.

Although physician burnout was a known problem long before the COVID-19 pandemic, the initial COVID-19 wave and then the Omicron variant wave pushed physicians and ICU teams to their physical and psychological limits.

The dramatic strains that the COVID-19 pandemic placed on the medical system made the public aware of the day-to-day stresses that healthcare workers were experiencing and thereby opened new avenues for doctors to express themselves and to get emotional support. Despite this, many healthcare workers, including critical care nurses, have experienced burnout and are considering leaving or have already left their positions, thereby further depleting the ranks of an already understaffed profession.

Some in the industry are even calling this The Great Resignation. The adoption of eICU / TeleICU has provided much-needed support and relief for the bedside staff. and could potentially be a long-term solution for this severe burnout problem.

Over 5 million people are admitted to intensive care units in the United States annually, a number that continues to grow even as hospitals face a shortage of critical care staff. Fortunately, advances in technology are making it possible to provide high-quality care to ICU patients even when there are not enough doctors physically present.

The eICU is one of many branches of telemedicine that is changing the way medical services are delivered for the benefit of patients and healthcare providers alike.
What is an eICU?
The terms eICU (electronic intensive care unit), tele ICU, remoteICU, and virtual ICU are all used interchangeably to refer to the same thing – a platform in which technology is used for remote care delivery to patients in the ICU.

Knowledge is power, especially in the medical field. This remark is even more accurate when it involves the intensive care unit, which is “intense.” ICU staff often must make critical care decisions in minutes or seconds. The uncertainty of these decisions and the tension this engenders, coupled with stresses of ICU bed and staff shortages in the face of increased demand, especially during the recent COVID-19 pandemic, highlight the importance of access to data for decision support. 

As health care has become increasingly complex, the industry has recognized the need for a knowledge system that can support critical healthcare decision-making.

What is needed is the use of experience-based data gathered regarding patients’ diseases and treatments in order to determine the diagnosis, prognosis, and best treatment for future patients. Such clinical data could also offer new perspectives on complex problems.

Hospitals across the nation have been creating Virtual ICUs to enhance patient outcomes in the intensive care unit. Since COVID-19, eICUs have proliferated – in one form or another — as healthcare facilities have focused on optimizing their resources.

Virtual ICUs employ registered nurses (RNs) with bedside critical care experience who use telemedicine technology as eICU RNs to remotely monitor patients and provide advice to their bedside nursing colleagues, and alert intensivists to something that has caught their attention during reviews. This additional ICU support has proven to be helpful, particularly given the shortages of critical care providers (especially intensivists and critical care RNs).

The COVID-19 pandemic has compounded the problem of staffing shortages, stressing already frustrated RNs to or beyond their breaking points. Nursing has always been a tough job. However, a 2021 study by Incredible Health found that more than a third (34%) of nurses surveyed said that they are very likely to quit their job by the end of 2022. Of these, 44% named a high-stress environment and burnout as the reasons. Also, pay and benefits were the second leading motivating factors (27%). In addition, the American Association of Critical-Care Nurses (AACN) reports that 66% of critical-care and acute nurses have contemplated quitting the profession altogether.

Having said that, what is it like to work as an eICU RN? What are the duties, and how does the Virtual ICU enhance patient outcomes?

During the COVID-19 pandemic, the US government waived many cross-state physician restrictions to increase the availability of remote clinical care. The expanded implementation of eICU telemedicine proved invaluable during the pandemic, particularly for hospitals in outlying regions. However, the waivers are slated to expire as soon as the federal pandemic-era emergency order ends. Advocates of virtual care are seeking long-term policy changes to prevent this.

The development of technology for healthcare is a natural evolution in the digitized world. Telemedicine, delivering healthcare by remote technologies, is not a new concept, but COVID-19 pushed it — and particularly eICU — into the forefront as the safest feasible method for doctors and patients to interact. In addition, telehealth resolved issues with in-person appointments such as social distancing rules and transportation limitations. Overall, in a time of great need, telemedicine unequivocally demonstrated and proved not just to skeptics but to society at large how it augments healthcare access for isolated individuals in a variety of settings. Moreover, the success opened many eyes to the possibility of additional benefits. One such potential benefit is the use of remote language experts, medical translators and interpreters, bridge language and cultural gaps, thereby allowing equal access to care.

The Tele Intensive Care Units market is growing by leaps and bounds. According to the latest Market Forecast by Verified Market Research, the TeleICU, or eICU, market size was USD 1.94 Billion in 2018 and is expected to reach USD 6.25 Billion by 2026, growing at a CAGR of 14.28% from 2019 to 2026.

The Report discusses the growth of worldwide and regional markets, shedding light on recent developments and key growth strategies. Also included is a special COVID-19 impact analysis. What is the market’s impetus and what are the trends to look out for?

Telemedicine has undergone significant advancement and improvement since the advent of the COVID-19 pandemic. During the pandemic, telemedicine has helped overcome many hurdles facing the healthcare industry. For instance, telehealth has enabled patients easy access to health care without patient and/or provider infection risk. In hospitals, eICU has enabled staff to minimize risky physical contact with patients and has given hospitals increased access to intensive care specialists despite their being in short supply. The challenges and needs of the COVID-19 pandemic drove a quick shift from reliance on traditional healthcare methods to the implementation of TeleICU and other telehealth modalities. The lessons learned from the COVID-19 crisis have been applied to the growing war-related, healthcare crisis in Ukraine.

The Emergency Care Research Institute (ECRI), a non-profit which focuses on patient safety, has issued a report outlining the top ten concerns that could jeopardize patient safety. The report is unique in that the focus is not on typical safety issues such as hospital-acquired infections or shortages of lifesaving machines like ventilators. Instead, the report deals with risks which are related to healthcare providers themselves. Here we explore these risks and how telehealth, particularly eICU, can alleviate them.

TeleICU is an increasingly vital cog in facilitating patient access to medical expertise. As the SARS-COV2 virus crisis (COVID-19) has exacerbated hospital staffing shortages, telemedicine has stepped in to create what can be described as ‘virtual hospitals.’

In the second installment of this series, we explore challenges in identifying hospital-acquired infections (HAIs) and the importance of teleICU or e-ICU.

How does one know it’s an HAI? Learn more about HAI >>>

Many people avoid hospitals for fear “catching something” they didn’t have beforehand. This fear may sound like a misconception or based in folklore or legend; however, there is actually some medical basis to it: hospital-acquired infections (HAIs). The alarming statistics of HAIs are another reason for hospitals to consider implementing TeleICU solutions. 

eICU and EHR. Now, more than ever, researchers are pointing out the potential value of incorporating EHR technology into eICU (electronic intensive care unit) systems as the industry evolves.

The thought or topic of a hospital ICUs (Intensive Care Units) raises feelings of fear and vulnerability in many. However, knowledge is power, and understanding more about ICUs, especially the benefits of TeleICU solutions, can put you at ease should you or your loved ones ever need to visit an ICU.

Medical technology has come a long way since the stethoscope, the MRI, and the disposable catheter. Today, many factors including Covid-19, that forced healthcare into the future, including a growing geriatric population

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The shortage of board-certified intensivists impacts patients, intensivists, and hospitals. So let’s examine the benefits of TeleICU for intensivists and hospitals in critical care medicine.

The disparity between ICUs with and without board-certified intensivists in the US is widening. TeleICU implementation continues to grow in the US, with 18% of adult ICU beds already covered by TeleICU

TeleICU implementation is a growing trend in the health care industry, among hospital systems, and among individual hospitals.

The importance of tele-stroke and Tissue Plasminogen Activator (tPA)

Tissue Plasminogen Activator (tPA) is a potential lifesaving medication which can be administered to certain stroke patients.

Today, rules and regulations are in place in most industries in an effort to ensure that best practices and safety standards are followed.

Over the last decade, there has been significant growth in TeleICU.

What role did tele-ICU play in meeting the challenges of the COVID-19 pandemic?

Tele-hospitalists can contribute by filling gaps, taking over burdensome administrative tasks, and improving patient outcomes and patients’ experiences.