Patients Benefit From ICU Telemedicine
It is about virtual teamwork and collaboration. Bedside nurses are patient advocates, and they are the key to building a successful foundation for virtual teamwork. ICU care is team based. It is axiomatic that you cannot provide the highest level of care without a well-functioning multidisciplinary team in the ICU. The Tele-ICU is just another element of that team. Intensivist participation in that model is very important. Skilled ICU nursing is mandatory. Facility leadership is vital. But none of that will be successful without authentic frontline physician buy-in and acceptance. Or at least it won’t happen optimally.
We’ve learned a lot through experience. Camera presence is huge. This is true for both sides of the camera and for both physicians and nurses, but it is particularly important for the Tele-ICU physicians. How the physician appears on screen, how she or he interacts with bedside staff—their courtesy, the clarity and cadence of their speech—impact how they are perceived and received by the patient site. Personality traits can be magnified on camera. We find that how a clinician appears in person may not be reflected in how they come across on camera. This is really important for building trust and relationships, and it works both ways. We’ve learned that some of our colleagues will respond in surprising ways over the camera. That can be a challenge, but we are constantly learning how to be more effective. You really have to emphasize the interpersonal niceties and collegiality.
FP: Hasn’t there been a recent collaboration with the DoD?
RB: Yes. We started working in April with a team from the U.S. Air Force. The clinical lead for DoD is Colonel Marc Goldhagen, director of Medical Modernization for Air Combat Command. The collaboration will enable ICU specialists (intensivists) from the Central VA ICU Telemedicine System to continuously monitor and assist in the care of critically ill patients.
The Central VA ICU Telemedicine system includes ICU nurses and physicians working from the Tele-Medicine Intensive Care Unit at the Minneapolis VA Medical Center. It also includes intensivists working from 2 additional linked locations, one at the Iowa City VA and another at the Hines VA.
The plan calls for Tele-ICU to serve ICU patients in 5 Air Force Medical Treatment Facilities, located in Alaska, Mississippi, Nevada, Ohio, and Virginia, covering a total of 20 DoD ICU beds. An additional 40 VA ICU beds is also part of the initiative.
The collaborative effort is supported by the DoD-VA Health Care Sharing Incentive Fund, also known as the Joint Incentive Fund, authorized by Congress as part of the 2003 National Defense Authorization Act. The funding is designed to cover start-up and implementation costs during the initial 2-year financial support period. The intent of the fund is to facilitate mutually beneficial exchanges of health care resources between DoD and VA. The goal is improving access to high-quality and cost-effective health care.
