Critical Care Symposium to Examine Role of Tele-ICUs in Improving Quality, Value

Formal telemedicine ICU programs support 11% of critically ill adult patients in non-federal hospitals, according to a 2014 study. This statistic speaks volumes in an era when 24/7 critical care units must meet quality improvement standards and continue to advance levels of care, while showing efficient use of ICU beds.

Scott Lindblom, MD

“Tele-ICUs allow critical care physicians to provide care for an exponentially larger volume of patients and at facilities that cannot afford or cannot obtain adequate critical care physician support,” said Scott Lindblom, MD, Specialty Medical Director of Adult Pulmonary and Critical Care and Chief of Pulmonary and Critical Care Consultants at Carolinas HealthCare System in Charlotte, N.C.

Dr. Lindblom will be among the presenters at the STS/AATS Critical Care Symposium: Quality and Value in the CT ICU. The symposium, from 7:50 a.m. to 12:00 p.m. Sunday in Room 128AB, will focus on the role of postoperative quality and value improvement initiatives in reducing morbidity and mortality, as well as leveraging expertise with telehealth solutions, hospital-acquired infections (HAIs), mechanical ventilation, and advanced life support.

Carolinas HealthCare System has operated a virtual critical care telemedicine program since May 2013 and currently covers 10 facilities with more than 250 ICU beds. The tele-ICU program provides after-hours coverage, daytime support for facilities without intensivists, and a method to obtain risk-adjusted data for quality reporting and process improvement.

“We have demonstrated improved clinical outcomes and clinical efficiency by implementing a virtual critical care physician evaluation on all patients within 1 hour of admission. We currently have 24/7 critical care RN support and 16-hour critical care physician support,” Dr. Lindblom said. “The daytime physicians have had a significant reduction in after-hours calls, and bedside RNs have a resource for clinical questions and bedside needs.”

Kevin W. Lobdell, MD

The program operates in conjunction with the Sanger Heart & Vascular Institute under the direction of Kevin W. Lobdell, MD, who is co-moderator of the symposium.

“We approached the symposium through the phases of care, along with risk assessment and mitigation, and then we considered each body system through these same phases of care,” said Dr. Lobdell, Director of Quality for the Sanger Heart & Vascular Institute at Carolinas HealthCare System. “Our comprehensive and systematic planning included historic registration data and feedback to ascertain that our offering would be current and respectful of what’s been done in the past, but also one that would allow us to learn and improve on how we presented these topics.”

The Importance of HAI Prevention

Emily Landon, MD will discuss infection prevention, HAIs, and antibiotic stewardship, including the Hospital Microbiome Project, which aims to collect microbial samples from surfaces, air, staff, and patients at The University of Chicago’s new Center for Care and Discovery. Dr. Landon, Medical Director of Infection Control at The University of Chicago, is the hospital investigator for the project.

Emily Landon, MD

“We’re conducting an ecological survey of the hospital environment as patients, antibiotics, and health care providers are introduced into the hospital space. We’re sequencing millions of samples, and the data are still coming in,” said Dr. Landon.

The 700-bed hospital also uses automated electronic technology to monitor hand hygiene 24 hours a day, collecting millions of hand hygiene events every month. Fewer staff miss work due to illness, and hospital-acquired infections have decreased in hospital units with better hand hygiene compliance, Dr. Landon said.

“The focus of my talk will be about advancing the science of health care-associated infection prevention and understanding the steps we need to take to prevent infections,” Dr. Landon said. “Our goal is to provide scientifically sound methods of determining policy and helping health care workers change behavior to improve compliance.”

The rest of the symposium will focus on the effect of HAIs on quality and value, cardiac surgery unit-advanced life support (see related article), and prolonged ventilation, including the ventilator bundle, prevention of prolonged ventilation, timing of tracheostomy, and extracorporeal membrane oxygenation.

Dr. Lobdell encouraged those who have roles in the evolving multidisciplinary cardiothoracic critical care team to attend the Critical Care Symposium, noting that they will leave with important information on quality and value.

Sanger’s Tele-ICU Program: By the Numbers

After implementing a tele-ICU program, Carolinas HealthCare System has seen a 7.3% increase in patient acuity and 1.7% more patients.

Despite these rises in patient acuity and volume, the organization has provided more efficient and effective care:

Overall risk-adjusted mortality Reduced 5.2%
ICU length of stay Reduced 7.4%
Hospital length of stay Reduced 2.3%