Telecritical Care Expands Telehealth From the ICU to Where It's Needed

As healthcare providers launch telehealth programs to improve critical care management and coordination, they’re seeing value far beyond the ICU.

Indeed, as the coronavirus pandemic taxes hospital resources and a growing shortage of critical care doctors becomes more apparent, hospitals and health systems are deploying telemedicine technology to treat patients wherever they’re located.

“This is telehealth at a different level,” said Jeff Guy, MD, MSc, MMHC, FACS, vice president of Emergency and Critical Care Services with HCA Healthcare, a Nashville-based network of some 186 hospitals and more than 2,000 care locations in both the US and UK.

Guy was part of a panel session at the American Telemedicine Association’s weeklong virtual conference last week. Titled “Implementing TeleCritical Care in a Healthcare Platform,” the discussion centered on how the concept of using telehealth to improve care is evolving, to focus more on delivering quality care than where that care is delivered.

A platform that began with a focus on improving care for stroke victims is now much more complex, with networks that allow large hospitals with specialists to reach out to smaller, rural hospitals that treat critical care patients regardless of whether they have an ICU. Through this platform, the large hospital at the center of the network can manage care across the enterprise, delivering specialized care and cutting down on transfers and traffic, while the smaller hospitals can keep and care for their patients on-site.

The concept of connected critical care has led to large networks like HCA, Providence Health in the Pacific Northwest, St. Louis-based Mercy Virtual and Utah’s Intermountain Healthcare, whose medical director for critical care telehealth, William Beninati, MD, was part of the panel.

Beninati pointed out the telecritical care platforms have become a means of standardizing critical care across the health system, giving the tiny hospital in a rural community that same access to care as the big-city hospital. This gives the small hospital the tools to care for more complex patients.

That point is being proven with the COVID-19 crisis. With a telecritical care platform, the large hospital is the hub of a hub-and-spoke network, using a dedicated facility or specialized call center to manage care in the spokes. It can help to balance the patient populations at all hospitals, reducing the need for costly and potentially dangerous transfers, while also helping to cut down on ICU traffic, provider exposure to the virus and even PPE use.

Both Beninati and Guy pointed out that today’s telecritical care platforms are purposefully built to be flexible, as each hospital in the system (and those outside the system who might be able to join the platform) has different needs and capabilities. The telemedicine platform should also be easy enough that a hospital with only the most basic resources can connect.

To that end, Beninati noted that Intermountain has added an asynchronous telehealth program to its roster of services, allowing those with limited access to or need of an audio-visual platform to connect through an online portal.

This also requires the coordinating hospital to train its specialists to be adept at virtual care.

“This is a very unique skillset,” Guy said. “Because you’re a critical care physician doesn’t mean that, by default, you’re a telecritical care physician.”

Among the challenges to launching and expanding such a platform, Beninati said, is the fear among smaller providers that the telehealth platform “sucks patients out of a community.” In contrast, he said, the services does the opposite, giving those small providers the resources they need to keep patients in the community – not only for in-patient care but also for post-discharge care, including virtual visits with specialists and rehab care providers.

Other challenges include EMR integration – Beninati says Intermountain’s network has to content with several different EMR platforms – and interstate licensure and credentialing, which can be a hassle for health systems spanning several states.

The benefits, meanwhile, include reduced ER traffic at the hub hospital, a steadier care environment at the spoke hospitals, reduced transports (and the clinical and financial toll that they exact), and certain clinical benchmarks like improved sepsis detection and ventilator care, reduced length of stay and a reduced risk-adjusted mortality rate.

Guy also pointed out the value in making sure the hub hospitals have a rapport with the care providers, especially the nurses, in outlying hospitals.

“The secret sauce of success is the people,” he noted.