Tele-ICU

Abstract

Independent organizations, supported by research, have recommended a standard of intensivist-led intensive care unit (ICU) staffing model given the association with improved ICU and hospital mortality (Hassan, Crit Care Nurs Q 41(1):47–59, 2018; Barrett et al., Utilization of Intensive Care Services, 2011: Statistical Brief #185. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD), Agency for Healthcare Research and Quality (US), 2016). However, this model can prove to be difficult to achieve due to a multitude of reasons such as financial resources and the limited availability of board-certified intensivists. In order to fill this need, Tele-ICU has been put forward as a potential solution to this lack of availability of certified intensive care providers. Tele-ICU is defined as networks of audiovisual communication and data systems to link hospital ICUs to intensivists and other critical care professionals at remote locations (Breslow et al., Crit Care Med 32(1):31–8, 2004). They can be designed to be one of three different models: centralized, decentralized, or hybrid. Each model comes with its own advantages and disadvantages, and the selection of which can depend greatly on geography, resource availability, and patient characteristics.

Telemedicine as an entity has been known for around 50 years; however it has experienced a slow evolution due to technologic constraints, regulatory issues, and lack of reimbursement. The initial concept of Tele-ICU was described by Grundy and colleagues in 1982 and fully implemented by the Sentara Hospital System in Norfolk, Virginia, in 2000 (Chen et al., J Intensive Care Med 33(7):383–93, 2018). The time period from 2003 to 2013 saw a rapid growth in the number of Tele-ICU systems, increased from 16 to 213, representing an increase of 61% per year but has slowed down over more recent years (Chen et al., J Intensive Care Med 33(7):383–93, 2018).