As the U.S. population ages, demand for critical care is rising, and intensive care units (ICUs) are often filled to capacity. At the same time, health systems are facing a significant shortage of intensivists to meet this growing demand. With today’s ICUs accounting for up to 50 percent of hospital mortality, many prolonged lengths of stay, and a third of hospital costs, it is often the first area of focus for healthcare executives looking to achieve cost savings and quality improvements.
A longtime pioneer in healthcare IT, the U.S. Department of Veterans Affairs (VA) has been addressing these challenges by implementing a comprehensive telehealth program for ICU care. The program enables VA intensivists to cover wide geographies and provide access to care to more veterans than they ever could have in the past.
The VA tele-ICU program
The VA represents a microcosm of the U.S. healthcare system and its challenges. The organization is charged with the care and welfare of the nation’s veterans, managing more than 1,700 sites and 1,800 ICU beds, and serving nearly 9 million veterans each year.
Philips Hospital to Home
In order to improve ICU care and expand its coverage to reach more patients, the VA offers a program of remote ICU care, referred to as “tele-ICU.” Deployed first in the Minnesota and Ohio-centered VA regions, the program allows clinicians to provide remote care to veterans not only locally, but also to rural and suburban areas where only limited intensivist expertise is available. By exporting this care knowledge from the VA tertiary medical centers to these distant facilities, the program allows more veterans to stay in their local VA hospitals, avoiding both transportation costs and the stress of transferring patients (and their families) to metropolitan critical care centers. This has the added advantage of keeping these tertiary hospitals more available to veterans who can only be served by the specialized services these hospitals can provide.
The VA’s program brings together intensivists to form a centralized “command center” team. This team – usually comprised of an intensivist and several highly trained nurses – has access to electronic medical records, laboratory, and real-time patient data. With the patient data and sophisticated analytics, intensivists are able to spot trends in clinical deterioration, enabling them to make proactive clinical decisions that avoid complications. This results in improved patient outcomes, reduced length of stay, and reduced costs for VA health.
The Philips eICU
Building off the success of these first two installations, the VA recently committed to expanding the program from the Ohio and Minnesota central sites. The Cincinnati-based team will now remotely monitor and manage ICU patients in the VA’s Southeast network (encompassing the states of Alabama, Georgia, and South Carolina), while the Minneapolis team will now manage additional patients in Illinois, Missouri, and Kansas. In all, the expanded eICU network will stretch across some 2,000 miles of VA facilities, reaching from Georgia to North Dakota, and will encompass more than 390 beds or 22 percent of the VA’s ICU beds across the country. With more than 15,000 veterans already served through this program annually, the VA is continuing to look to grow in other regions of the country to serve even more veterans.
The VA model across the U.S.
Other health systems are already seeing substantial clinical and financial results from eICU programs. In a recent study published in CHEST Journal, a team of researchers led by Craig M. Lilly, M.D., Professor of Medicine, Anesthesiology and Surgery, University of Massachusetts Medical School, examined the impact of an eICU program across 19 U.S. health systems. The study of 120,000 patients found that those who received their ICU care as part of an eICU program were 26 percent more likely to survive the ICU and 16 percent more likely to survive hospitalization and be discharged.1 Those patients were also discharged from the ICU 20 percent faster, and from the hospital 15 percent faster. With only 11 percent of all U.S. ICUs employing a tele-ICU program, these results point to a significant untapped opportunity for additional telehealth programs in this space.2
The VA has realized the benefits of leveraging technology to improve patient outcomes and is poised to be a leader of this much-needed redesign in critical care. Other health systems in the United States and abroad have the opportunity to model the VA program in their own ICUs. These telehealth centers can help providers respond to caregiver shortages, while improving productivity, the quality of care, and the access to care for patients. Ultimately, the patient experience needs to be at the center of all clinical programs, and eICUs are built around the goal of providing the very best care possible.
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