Remote clinics often don’t have the resources to have highly specialized experts on staff to manage difficult patients, but these days there’s an option of actually outsourcing ICU (intensive care unit) services. Advanced ICU Care is a company that offers tele-ICU capabilities that bring intensivits (critical care specialists) located far away into a small clinic using a bunch of advanced technology. The tele-ICU team has live access to patient telemetry and is able to see and communicate with the bedside team. We spoke with Dr. Ram Srinivasan, a physician who splits his time between on-site ICU work and off-site tele-ICU visits. His experience was something we wanted to prod at to get a better idea of how tele-ICU works in the real world.
Medgadget: Dr. Srinivasan, you see patients as a typical ICU physician as well as via the tele-ICU system. Can you describe how you’re able to help manage critical patients while many miles away and how that’s different from a typical ICU experience?
Dr. Srinivasan: I draw upon the same experience and skills when practicing as a tele-Intensivist as I would at the bedside. The focus to deliver the best outcomes for critical patients is the same, but the vantage point is different. To illustrate, as a tele-ICU physician, I jump into an air traffic control role while the bedside physician is the pilot. I can step back, assess, and draw upon a wider view not always available when you are actively tied up at the bedside. Since I serve in both roles, I can anticipate how best to complement the work of the bedside teams as we work together to ensure patients have 24×7 access to an intensivist and evidenced-based medicine built on best practices.
Medgadget: What telemetry and data do you receive while working remotely and are there any challenges in being on the same page with the staff directly handling the patient?
Dr. Srinivasan: Our systems tie directly into hospital systems, and we, therefore, have real-time access to all the data I would have if I were present at the hospital. In fact, because I am always in front of my twelve monitors I have “real-time” access versus needing to leave the bedside to retrieve data which are not on bedside monitors. Our teams can even be alerted while the patient is still in transport, before they even reach the ICU, and we can begin preparing for the patient’s arrival by reviewing records or preparing orders.
Medgadget: What kind of clinics do you see as benefiting the most from tele-ICU?
Dr. Srinivasan: To the layperson, tele-ICU is a pretty obvious solution to any intensive care setting where access to intensivist physicians is not available 24×7. But honestly, tele-ICU is really the new standard of critical care for hospitals of different sizes and capacities. Whether or not there is an intensivist physically at the patient’s bedside, there are quantifiable benefits in reducing lengths of stay and improving outcomes that reinforce that tele-ICU. It is what I would want as a patient or for a family member.
It is not just the hospital and its patients that benefit from tele-ICU. We also help bedside physicians shoulder the weight of patient care and the pressure that comes with the profession. We can help the local doctors achieve a better quality of life. They know we’ve got them covered when they’re with other patients or away from the hospitals, so they can remain integral figures in their home life and communities.
Medgadget: In your experience, how do patients and families feel when a physician taking care of them is nowhere near? How do you help bridge the gap?
Dr. Srinivasan: Responses certainly vary by person and can be influenced by their comfort with technology. It can vary for physician to physician and physician to nurse interactions as well. But, even for people who are hesitant initially, I see acceptance and engagement take hold in time. Being on the other end of the screen takes skills that we aren’t usually taught in medical school. There are definite ways to go about building trust, knowing how to connect and build rapport despite a lack of physical presence in the hospital. As more and more people are accustomed to using services such as Facetime or Facebook Live to connect with family or friends, I do believe the newness of the interaction will wear off. Just last week, I had a very critical conversation with a family about end of life care for their loved one. The conversation had to take place in the evening when all family members could be present, but it didn’t coincide with the bedside physician’s availability. He and I conferred, were aligned, and I was able to have a rich and positive conversation with the entire family which was very important to them. It reinforced to me the importance of not restricting care to time and place when we have the technology that can erase those boundaries.
Medgadget: Are there regulatory, technical, or other limitations that you’ve experienced?
Dr. Srinivasan: None that have limited our work. Integration with hospital systems is always the most technical aspect but we have successfully implemented services with more than 30 different EMR configurations. Advanced ICU Care’s experience and a thorough implementation process go a long way to overcome any obstacles or address any challenges so we are ready to partner when the hospital is counting on us.
Medgadget: Are there aspects to this technology that make it in some cases superior to direct care?
Dr. Srinivasan: With tele-ICU, it’s not an “either/or” discussion, it’s “and”. 24/7 tele-ICU is additive. We complement the work of the bedside team with an arsenal of experienced clinicians, data intelligence, and clinical best-practices to provide excellent care to our critically ill patients.
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