The rise of teleICUs

According to Deena Costa, a professor at the Yale School of Nursing and a former ICU nurse, teleICUs first became popular in the mid-2000s after studies suggested patients in the ICU would benefit from having intensivists, or experts in ICU patients, available 24/7. Before this, many hospitals did not have intensivists available overnight.

In 1998, two intensivists at Johns Hopkins Hospital founded the company Visicu to provide teleICU technology to hospitals. The company was later acquired by Philips in 2008, and it has become the leading company for teleICU services.

In 2010, less than 5% of total ICU beds in the United States used telemedicine critical care, which later increased to around 18% in 2018. During the COVID-19 pandemic, interest in teleICUs grew even more, with recent estimates suggesting that around a fifth of U.S. hospitals currently use teleICUs.  

As hospitals face growing financial pressures and staffing shortages, teleICUs can help provide the perspective of a critical care doctor without having to pay for one to be available at all hours. A remote physician can cover multiple hospital ICUs at once, which helps keep them open and revenue coming in.

Having a remote intensivist can also be beneficial for patients in rural areas, said Nandita Nadig, an associate professor at Northwestern University's Feinberg School of Medicine and a critical care doctor. These remote physicians can help spot red flags in care or help patients stay in their communities instead of being transferred to far-away facilities with in-house intensivists.

Some research has also found some financial and patient care benefits related to teleICUs. For example, one study cited by Philips found that teleICUs increased case volume by 44% and helped hospitals save tens of millions of dollars by reducing the need for on-site doctors. Another study, which was funded by Philips, found that, between 2012 and 2020, hospitals with telecritical care capabilities had lower patient death rates in the ICU, as well as shorter ICU stays.

TeleICU technology is used "to extend access to intensivist expertise, support bedside clinicians, monitor patient populations and help identify patients who may need earlier intervention," said Martijn Hartjes, an executive who leads hospital patient monitoring at Philips. 

Are teleICUs negatively impacting patient care?

Although teleICUs can help hospitals reduce costs, they may not always be beneficial for patient care, especially if they are not implemented effectively.

"It can definitely be misused if the goal is to make the spreadsheet look good and staff as many beds as possible with one doctor," said Eric Scholten, who works as a teleICU doctor in a health system in the American West. 

"I started thinking about the guy in the screen, and thinking, 'What the hell was that?'" said William Hylton, Conor's father. "Why wasn't there someone at his bedside?"

Some nurses have also expressed concerns about the growing use of teleICUs. For example, Joyce Selph, a longtime nurse, said she left her previous job at a Washington hospital because she felt the teleICU was endangering patients' safety and pushing her to practice outside of her scope.

"They did it as a cost-saving measure because they were having trouble getting hospitalists to want to be there," Selph said. "But I felt very strongly that it was unsafe."

Although there are growing concerns about teleICUs, some physicians say that they can still be helpful, especially as patients get older and need more complex care. Because the United States currently has a shortage of intensivists, having access to teleICU physicians can be better than having no intensivist at all, Nadig said.

According to Scholten, teleICUs can work well, but remote physicians need to be familiar with the hospital system and the doctors who work there, and hospitals need to have clear processes for what nurses should do when patients are deteriorating rapidly and no in-person physicians are available.

"It takes a lot of resources to make [teleICUs] work well as a service to keep people in their local community," Scholten said. "… It can go awry when they just say, 'We're getting rid of bedside coverage, and you just call this person who's a long way away and doesn't know the culture.'"

Overall, health experts say that teleICUs work best when they supplement the care provided by bedside physicians instead of replacing them altogether.

"The reality is that not every place is desirable to raise a family or build a life, so you do need some of this backstop — I do believe there's a place for it," said Allison Harriott, a critical care and emergency medicine physician who has researched teleICUs. "But can it fully supplant what I do at the bedside? I don't think so."