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Telemonitoring in the ICU


By Bisk
Telemonitoring in the ICU

 

The American Association of Critical-Care Nurses (AACN) has defined the term “tele-ICU” as the process of utilizing remote monitoring systems in the delivery of intensive care services. A remotely based critical care team is networked with the bedside ICU team and patient via state-of-the-art audiovisual communication and computer systems.  One example of a tele-ICU relationship is a major teaching institution linked with a rural hospital that does not have a trauma unit.

Physicians, nurses and other critical-care specialists can receive clinical data electronically, create medication orders and communicate with on-site caregivers to implement changes in patient care. The terms “tele-ICU,” “virtual ICU,” “remote ICU” and “eICU” all refer to this same patient care concept.

The technology allows 24-hour coverage of critically ill patients in geographic areas that are underserved or have limited resources. Some healthcare professionals consider tele-ICU as one method of dealing with what a May 2012 article in the Journal of Hospital Medicine called a “growing shortage of intensivists.”

Considerable financial investment and organizational restructuring may be necessary when implementing telemonitoring for ICU patients, so the potential benefits and disadvantages should first be carefully assessed. The on-site specialists must also be supportive of the tele-ICU professionals and prepared to participate fully for positive patient outcomes.

Research into Tele-ICU Practice

The authors of a study presented at the American Thoracic Society International Conference in May 2011 stated that, “In a meta-analysis including over 40,000 critically ill patients, we found no statistically significant difference in hospital mortality between critically ill patients who received ICU telemonitoring and those who did not.”

However, the authors noted the potential of remote telemonitoring to help patients in areas without access to physicians trained in intensive care, who are known as intensivists. The authors called for more large-scale studies, adding that tele-ICU had been introduced in more than 250 hospitals in 30 states.

In contrast, a study published in the June 2011 edition of The Journal of the American Medical Association cited several positive outcomes related to the use of tele-ICU, including:

  • Hospital mortality rates fell from 13.6% to 11.8%
  • Average hospital stays decreased from 13.3 days to 9.8 days
  • Significantly fewer surgical ICU patients required mechanical ventilation and those who did had a shorter duration of ventilation
  • Rates of ventilator-associated pneumonia and catheter-related bloodstream infection were reduced

Certification for Tele-ICU Nurses

Just as physicians can be trained as intensivists, RNs can achieve certification as tele-ICU nurses. The AACN has expanded its certification program to include the CCRN-E for “nurses working exclusively or primarily in a tele-ICU … behind the camera observing live patients from a remote location.”

According to the association, tele-ICU nurses monitor critically ill patients remotely and offer coaching and guidance to on-site bedside nurses. The AACN website details the eligibility requirements and other information related to the CCRN-E certification.

Although more large-scale studies are needed to generate universal support for tele-ICU, its benefits in terms of staffing and patient outcomes likely will continue to draw attention from healthcare facilities. As noted by the authors of the study presented at the American Thoracic Society International Conference, “Unfortunately, there is (and is expected to be) a shortage in intensivist physicians over the coming decade.”

Category: Healthcare