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April 2, 2020

How hospitals in Covid-19 'hotspots' are leveraging tele-ICUs

Daily Briefing

    As hospitals around the country run out of ICU beds and staff to treat COVID-19 patients, some are finding new ways to deploy tele-ICU technology to increase their ability to monitor patients, Christopher Mims reports for the Wall Street Journal.

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    Tele-ICUs typically consist of a two-way bedside video chat program that connects clinicians with critically ill patients at their bedsides. Unlike a face-to-face ICU, in the tele-ICU, patients might be miles away from their doctor, or even in a different state.

    To help providers best see patients, the setup usually includes high-definition cameras that can pan, tilt, and zoom throughout a patient's hospital room.

    While the tele-ICUs prevent the remote clinicians from doing anything in patients' rooms that requires using their hands, like adjusting a ventilator, they can zoom in on patients' monitoring equipment to check their vital signs remotely. Patients are connected directly to important equipment, such as blood-pressure and heart rate monitors.

    When it comes to infectious disease patients, Mims explains, using a tele-ICU to check on patient "saves [providers on the ground] 10 to 15 minutes of suiting up in protective gear," Mims writes.

    How hospitals are using tele-ICUs

    Northwell Health

    At Northwell Health's telehealth command center, clinicians are monitoring more than 130 ICU beds, 116 of which are COVID-19 patients, across the system's 23 hospitals, according to Kara Benneche, director of clinical operations of telehealth services.

    Clinicians at the command center sit in front of six to eight monitors that connect them to patients via two-way video conferencing. One of the systems provides doctors with a live feed of their patients' vital signs and alerts physicians when a patient's vital signs are in dangerous territory.

    In April, Northwell will receive 35 movable carts that have two-way video conferencing capability, which will be used to connect to ICU beds during the pandemic. The carts, which can wheel around between rooms, can be moved to where they are most needed.

    As the number of COVID-19 patients increase, the tele-ICU technology will allow Northwell to increase its number of ICU beds from 170 to 420. "That's the beauty of tele-ICU: One person sitting in a tele-ICU center can take care of 50 to 100 beds," said Saurabh Chandra, medical director of telehealth services at the health system.

    Emory Healthcare

    Four hospitals in the Emory Healthcare system are using tele-ICU technology to support their on-site staff. With the tele-ICU, remote physicians can monitor stable patients while on premise staff can focus on other procedures, such as intubating a patient with COVID-19, said Timothy Buchman, medical director of Emory's tele-ICU service.

    "In situations where requirements and demands are changing rapidly, the ability to move from one room to the next, or one hospital to the next, literally at the speed of light, allows us to make the most efficient allocation of what are increasingly scarce human resources," he said.

    Swedish health system

    In Seattle, providers at Swedish health system are using tele-ICU technology to limit health care workers' exposure to COVID-19 and to keep people out of the hospital. Namely, according to Mims, one goal of the tele-ICU is to "kee[p] the scarce supply of trained intensivists physically removed from patients to minimize their risks of infection."

    Elizabeth Meade, the medical director of pediatric quality and safety at Swedish, said that of all the programs in place to help mitigate provider shortages at Swedish, she thinks "the tele-ICU capacity is the most important one at this time."

    The limitations of tele-ICUs

    Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security and author of a report on the impact of COVID-19 in the United States, said that while tele-ICUs can "improve our capacity to have trained people provide care … they're limited."

    For one, tele-ICUs do not help physicians achieve authorization to work at different hospitals. Similarly, states usually do not allow doctors to practice medicine without a state license. 

    That means tele-ICU functions may not be as useful if the virus were to peak before more providers could get authorized to practice in a way to benefit from it.

    Time and money present hurdles, too, as tele-ICU technology can be expensive and take weeks to be delivered and installed. That timeline isn't conducive to an influx of COVID-19 patients in some coronavirus hotspots, Mims reports.

    To make do, some providers are turning to commercial tablets and other technology that can be more easily installed in order to expand their ability to monitor patients, according to Mims (Mims, Wall Street Journal, 3/28).

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