In 2016, after several years in the making, Barnes-Jewish Hospital is implementing phase one of an intensive care unit (ICU) telemedicine program to initially support 81 ICU beds on its south campus. The added support will come from a 24/7 critical care team in a newly constructed monitoring center.
The program is the result of the drive to continually improve patient outcomes and the need to more consistently meet the high demand for BJH ICU beds.
The intensivist-led team in the monitoring center will have real-time access to all electronic medical record, laboratory and monitoring data, along with the capability for two-way audiovisual communication with bedside ICU caregivers. Additionally, the team in the monitoring center will use sophisticated clinical software and technology to detect problems and prioritize needs of individual patients.
“This program is intended to provide additional support for our bedside teams of ICU physicians and nurses,” said Walter Boyle, MD, professor of anesthesiology and surgery, and executive medical director. “It adds a layer of safety and support for our most critically ill and injured patients.”
Dr. Boyle, together with John Lynch, MD, Vice President and Chief Medical Officer, and a team of organizational leadership are working together to facilitate the move to this innovative new program.
According to Brian Riordan, the program manager, “A successful ICU telemedicine program will provide an added layer of care and safety which would be helpful particularly at night when there are fewer staff members in the ICU. The 24/7 monitoring and support allows proactive intervention with reductions in complications, and the collaboration among the team members will allow for consistent implementation of best practices and process improvements.”
The ICU telemedicine program is being launched in three six-month phases: pre-implementation, January-June 2016; implementation, July-December 2016; and post-implementation, January-June 2017.
With the additional support for the bedside ICU team members, the ICU telemedicine program is expected to have a positive impact for patients and the organization in several key areas. The program will be specifically evaluated for effects on:
- Patient mortality rates
- ICU and hospital lengths of stay
- Cost of care
- ICU capacity
“There was an important study published in (The Journal of the American Medical Association) a few years ago that pointed to the value, in an academic medical center such as ours, of providing this additional layer of support,” says Dr. Boyle. “We’re going to carefully re-evaluate that here and make sure it makes sense for us before making broader investments in this technology.”
“Even though we are very good, we believe the program will allow us to be able to further reduce mortality. We also believe we can reduce length of stay in the ICU, and thereby reduce the cost of care,” says Patti Crimmins-Reda, executive director of the program. “This will create added ICU capacity so we can take care of more patients. Before and after outcomes will be compared in order to judge the impact of the program.”
Another important indicator of the quality of ICU care the team plans to evaluate is discharge location – whether patients are discharged to home or go to nursing facilities or long-term acute care facilities.
“We’ll also look at hospital and ICU readmission rates, patient and family satisfaction, provider satisfaction and retention, the use of ancillary services and a panel of financial outcomes to evaluate the impact of this program,” says Riordan.
“We’ll have the ability to be virtually present in the ICUs where we have patients and be able to collaborate with the bedside clinicians who are taking care of them,” said Crimmins-Reda. “It’s going to be a two-way process. Either the monitoring center can see something happening to a patient in real time and call the clinician in the ICU, or the ICU clinician can call and say ‘I’m seeing something, what do you think?’ This is really state of the art, and is going to make for a safer environment.”