“There’s always the risk that acuity or volume can outstrip your ability to care for all the patients in your hospital,” he says.
In tele-ICU settings, remote clinicians and their bedside colleagues leverage technology, expertise and intense collaboration to make sure that doesn’t happen.
Houston Methodist Gets a Head Start on Its Tele-ICU
The January opening of a new tele-ICU at Houston Methodist couldn’t have been timelier.
The operations center supports nearly 250 intensive care unit beds across three of the organization’s eight campuses — coverage that will soon expand to more than 300 beds. Bedside and operations center clinicians, together with intensivists based in New York, coordinate care within what Pletcher describes as “an ecosystem of technology.”
In patient rooms, teams collaborate via two-way audio and Sony high-definition, pan-tilt-zoom cameras. The latter tool provides a bird’s-eye view into each room, close enough for a clinician to see a pupil dilate or to read a medicine bottle.
In the operations center, which is outfitted with Dell monitors, Lenovo PC workstations and Cisco phone systems, teams have a wealth of data at their fingertips. An Intel-powered Sickbay platform pulls data from a variety of sources — including bedside monitoring, biodata and electronic health records — to identify trends, analyze risks and produce alerts.
When COVID-19 hit in March, mobile carts equipped with iPad devices extended tele-ICU support throughout the Houston Methodist premises by allowing remote teams to monitor patients who came to the emergency department and then transferred to another unit, with the goal of preventing escalation to the ICU.
The carts also helped remote teams consult on COVID-19 patients waiting for ICU beds. During a recent spike of cases in Texas, guidance from the New York partners — battle-tested from their own surge — was critical.
“Getting intensivist expertise to a patient as quickly as possible improves outcomes, so by extending that resource into an area outside the ICU, we’re getting a head start,” Pletcher says.
Northwell Health Quickly Ramps Up Its Rollout
In New York, Northwell Health has relied on tele-ICU infrastructure in several ways during the public health crisis: supporting bedside nurses, providing critical care guidance to pop-up ICUs and quickly onboarding two more hospitals into the tele-ICU program.
Now 6 years old, Northwell’s tele-ICU covers about half of its 400-plus ICU beds across a 23-hospital system, with plans to cover up to 300 total beds by next year, says Iris Berman, the organization’s vice president of telehealth services.
The Syosset, N.Y.-based command center has a wide reach: With one nurse for every 40 beds and one intensivist for every 200 beds, the remote team relies on eight monitors, two CPUs (half for high-quality video and half for documentation systems), robust Phillips e-ICU software and, in patient rooms, HD PTZ cameras and two-way audio.