Twenty years ago, Sentara Healthcare became one of the first U.S. health systems to install a tele-intensive-care unit, and it’s harnessing those capabilities today in a new way: responding to COVID-19.
Norfolk, Va.-based Sentara began its tele-ICU program in June 2000 at two hospitals to give the chaotic and complex ICU setting an extra set of clinical eyes that would help improve patient outcomes including mortality and reductions in length of stay. Now with the program at eight of its 12 hospitals, patients with coronavirus symptoms are monitored 24/7 by nurses in a command center with real-time access to patients’ vital signs and labs. The technology has allowed Sentara to conserve personal protective equipment because nurses no longer have to enter patient rooms for more routine monitoring like checking settings on a ventilator.
“We are able to reduce the bedside provider contact,” said Dr. Steven Fuhrman, medical director of Sentara’s tele-ICU program.
There are also voice and video capabilities in patient rooms, which allow the tele-ICU nurses to virtually interact with patients if they have concerns or are in distress. It’s been especially important now when patients can’t have visitors, said Cammie Kelly, a tele-ICU nurse. “We’ll camera in and explain that we are an extra set of eyes watching you and taking care of you,” she said.
Sentara already had a strong track record with the technology. Since implementation, the tele-ICU program has contributed to a 26.4% decrease in hospital mortality and a 17% decline in ICU length-of-stay, according to the system.
Still, the overall evidence behind tele-ICUs is mixed, with some studies finding 24/7 monitoring of ICU patients led to decreased mortality and length of stay while others found no such improvement. Tele-ICUs also haven’t been widely adopted in the last two decades, largely because of costs. It’s estimated that telemonitoring costs about $50,000 per ICU bed each year. In 2018, about 27% of hospitals had telemonitoring capabilities in their ICUs.
The operating costs for Sentara’s tele-ICU are about $23,000 per bed, per year, with 132 ICU beds part of the program, Fuhrman said. The cost of Sentara’s ICU program is lower than the national average because a physician is only present for the night shift, which lasts 12 hours each day, he said. When the system first launched tele-ICU monitoring, a physician was present 19 hours a day. Furhman added many other hospitals nationally have done something similar in recent years and the $50,000 figure is likely outdated now.
In the years since Sentara started the tele-ICU program, changes have been made to encourage buy-in from clinical staff. Initially, some bedside ICU nurses were confused about the program. There were concerns about someone critically watching them work or coming in to correct them constantly. But over the years Sentara has focused on educating new nurses about the program during orientation so it’s not such a shock.
Furthermore, the tele-ICU nurses use tactics that help build a positive relationship with the bedside nurses. For instance, Ona Uriri, a nurse in the tele-ICU, said she always introduces herself when she calls a bedside nurse and then approaches a concern she wants to bring up as a question.
“You kind of humble yourself,” she said. “When I call people, I have a questioning attitude (and say things like), ‘Hey, I was wondering,’ versus, ‘Why is this this way?’ Because people can be very offended by that kind of tone.”
Uriri said she now gets calls from nurses on the floors asking for assistance.
Those working in the command center are seasoned ICU nurses and typically want to do the role to get a break from the physical demands at the bedside. “It’s the perfect environment for the more senior nurse,” said Mirna Medina-Gonzalez, a nurse and clinical manager of the tele-ICU.
Correction: Sentara operates its tele-ICU program in eight of its 12 hospitals. An earlier version of this story gave the wrong number for hospitals involved.