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Telemedicine in the ICU: How One Hospital Improved Care Management

Florida Hospital New Smyrna is using a telemedicine platform to improve patient care in its 12-bed ICU. The tele-ICU service is also making life better for the small hospital's doctors and nurses.

Source: ThinkStock

By Eric Wicklund

- A small Florida hospital is finding that a telemedicine platform gives its doctors and nurses the best means of caring for their sickest patients.

Executives at Florida Hospital New Smyrna, a 112-bed facility in New Smyrna Beach, just south of Daytona, have partnered with Advanced ICU Care to give patients in the hospital’s 12-bed Intensive Care Unit quick access to intensivists via a tele-ICU platform. The telemedicine service gives hospital staff a virtual link to specialist care whenever they need assistance.

Ken Mattison, the hospital’s CEO, says the move was made to improve patient care and give the hospital’s small staff some much-needed backup.

“There needed to be a way for us to focus on making the patients as safe as possible,” says Mattison, who joined the hospital in 2016. Florida Hospital New Smyrna is part of the 45-hospital Adventist Health System of which Mattison has been a part for more than 40 years.

“ICU patients have come in sicker and sicker as time has passed,” he says. “They strain the resources of smaller hospitals, and we’ve always taken seriously the patients’ safety component … so this seemed like an obvious choice.”

READ MORE: Telemedicine Study Cites Tele-ICU’s Positive Impact on Patients

“There is absolutely no downside to asking for help,” he adds.

The tele-ICU platform has proven beneficial to both large and small hospitals across the country, for different but equally compelling reasons. Smaller facilities, especially critical care hospitals in rural parts of the country, deal with smaller populations, staff and funding, a tricky combination that often hinders their ability to fully staff an ICU unit at all times or respond quickly when a patient in need of care comes to the facility.

That’s where telemedicine comes into play.

In some cases, those smaller hospitals will join a hub-and-spoke network managed by a larger health system, where access to intensivists and specialists is easier. The hub hospital leases its services out to the spoke hospitals, offering ICU care on demand through the virtual platform.

In other cases, hospitals partner with telemedicine companies who set up their own hub and spoke network. Advanced ICU Care, based in St. Louis, is one such company, serving more than 65 hospitals in 25 states.

READ MORE: Telemedicine Success Requires an Alignment of Incentives (and Attitudes)

In either case, the smaller hospital gains access to intensivists and specialists through a telemedicine platform at a moment’s notice, enabling them to better staff ICUs during nights and weekends, give their on-site staff more support, and keep their patients in the community rather than transferring them to a larger facility somewhere distant.

“Everyone does seem to be happier,” says Mattison, whose hospital has three intensivists on staff. “They feel better supported.”

There’s also an improvement in response time. Prior to using telemedicine, a nurse would have to call the on-call intensivist in an emergency, which might take five to 15 minutes. Through a virtual platform, an audio-video connection is established in seconds, if not minutes.

“All they have to do is push that button and someone is there almost instantly,” Mattison points out. And it’s much easier and less stressful for on-site staff, he adds, who may have a simple question that might not rise to the level of a phone call at an odd hour.

“They feel less guilty pushing a button,” he says.

READ MORE: In Value-Based Care, Telehealth’s Aim is Money Saved, Not Earned

Mattison says the tele-ICU program, launched some three months ago during a hospital remodeling project, didn’t come without its challenges. Aside from setting up the telemedicine technology in ICU rooms, executives had to make sure the platform was integrated with the hospital’s EMR, train staff to use the technology, modify policies and procedures to integrate the service and make sure it fit smoothly into staff workflows.

“This has become the standard of care for us,” he says.

That will be important as the hospital moves forward. Mattison says small hospitals often struggle to meet federal guidelines on establishing timely ICU care because of that lack of resources.

“We have found that, to meet those standards, we need technology,” he says. “And it’s working for us. I’m now looking forward to seeing the next cycle of Leapfrog scores.

One hurdle yet to be conquered is reimbursement.

“We still can’t pay for telemedicine through traditional charges,” Mattison says, noting the hospital does have a telestroke program and is exploring a telemental health service. “We’ve had to subsidize this through other programs, so I’m hesitant to start building up.”

“But in the end, it’s still the right thing to do for patients.”

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