Tele-intensivists

Our local hospital sent out a press release.  It turns out our hospital… 
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… “will soon have the benefit of the most advanced telemedicine program available in hospital intensive care units today.”  The hospital “will partner with Hicuity Health®, the nation’s largest provider of tele-ICU services, to deliver monitoring by highly trained intensivist physicians and critical care specialists 24 hours a day, 7 days a week, providing an extra layer of care that enhances patient care and safety.

“This new partnership with Hicuity Health is part of our commitment to continually innovate and improve services for our patients and our community…” With the addition of around-the-clock telemonitoring by intensivist physicians to the level of quality care already provided by our ICU team and physicians in the hospital, our ICU patients will receive the highest level of medical care available today.”
“Tele-ICUs are becoming an integral part of critical care services,” noted Lou Silverman, CEO of Hicuity Health. “Our team is pleased to collaborate with the physicians and clinicians…, supporting them in providing care for our mutual patients.”

Independent studies demonstrate that this 24/7 intensivist monitoring significantly improves patient outcomes and patient safety in the intensive care unit. In a study published in the Journal of the American Medical Association (JAMA), implementation of a tele-ICU program was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with improvements in best practice adherence and lower rates of preventable complications. Another study published by the New England Healthcare Institute (NEHI) recommends that community hospitals with 10 or more ICU beds adopt tele-ICU care.

Hicuity Health’s team of intensivists and critical care nurses work around the clock from centralized operations centers…The program continuously monitors patient vital signs, labs, and the patient’s clinical status. Proactive data management tools identify problems before they become urgent, prompting immediate intervention when necessary. In-room audio/video is utilized during periods of evaluation or when called on by the nurse. This two-way communication enables face-to-face consultations between the bedside staff and the Hicuity Health team, ensuring that help is available when needed.”

——-What do I think of this?  It fundamentally violates all of the principles of my old style Internal Medicine training. I hate this virtual doctor thing.  On the other hand, there is a certain reality in the ICU which has grown worse in the past two years.

In short, bad stuff happens in the ICU. The worst times to be in the ICU and unstable as a patient are night times, weekends, holidays or times of short staffing.  Doctor rounding in the ICU is incredibly time consuming and complicated.  To do it right, you need to round many times a day, which is something that rarely happens. Patients go from being hypotensive to fluid overloaded.  They get septic or bleed.  They do it when the doctor is least able to make a face-to-face encounter.   In this age of Covid, doctor rounding has become increasingly distant, anyway.  Over the past two years,  doctors have often even rounded from outside the room, looking into the window and relying on the nurse reports.  Many ICU’s rely on physician extenders and the results are often suboptimal. So, bottom line:  I can see a potential improvement of care, but I’m a skeptic.