Tele-Intensive Care Units: Technology at the end of life.

Intensive Care Units (ICUs), representing a major facet of health care in U.S. hospitals, now treat six million of the sickest and oldest patients every year. One of every five older adults dies in an ICU. The Health Resources and Services Administration (HRSA)—remains the primary federal agency for improving health care access for people who are uninsured, isolated or medically vulnerable. HRSA reports that patients in acute care hospitals receive more than 18 million days of care in ICUs each year. Already costing almost one percent of U.S. gross domestic product, the demand for ICU services is projected to grow rapidly during the next decade as the older adult population increases. The ability of critically ill patients to receive adequate care depends upon a number of factors. A 2002 HRSA Report to Congress projected that there will be a shortage of highly-trained ICU physicians (known as intensivists), the other possibility to meet the demand is to see if health care efficiency can be improved.

This is where “telemedicine ICUs” come in. In Tele-ICUs an intensivist physician and four nurses in one command center can oversee the care of up to 75 patients in distant ICUs. These clinicians are aided by “smart” databases that track patients’ clinical values and alerts the local ICU staff when signs indicate a negative trend or when a change in treatment is scheduled according to protocols. The local ICUs, staffed with physicians and nurses providing direct care to patients, do not have to be intensivists.

A recent study in 2007 by Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute (NEHI) reported that Tele-ICUs saved lives. The study found other benefits. Tele-ICUs decreased mortality by 20 to 36 percent, shortened ICU stays by 30 percent, and recovered up-front investment costs in less than one year. Tele-ICUs also enabled community hospitals to care for a substantial portion of patients who would have been transferred to teaching hospitals. Retaining these patients in community hospitals saved the payers approximately $10,000 per patient. Although these outcomes may vary, Tele-ICUs are providing a reasonable way of addressing the projected cost increases of ICU care. Our investment in improving this technology merits close attention. And there are some applications that are at the forefront of technology right here in San Diego.

The Veterans Administration Desert Pacific Healthcare Network runs the Care Coordination Home Telehealth program (covering San Diego) using nurses who can provide care coordination services to up to 150 patients a day. While at a more local level, the San Diego-based Council of Community Clinics is using telemedicine to reach and serve residents of rural community clinics and health centers by using video conferencing to  provide rural residents with access to specialty clinical services and to educate and train rural healthcare providers. Although these are still at an early stage of development, it will only be a matter of time before technology will be applied to tailor health care to frail and dying older adults.