Marc Zubrow is the Vice-President of Telehealth and an Associate Professor of Medicine at the University of Maryland School of Medicine. As Medical Director of eCare at the University of Maryland Medical Center, he has specialized expertise in the burgeoning field of critical care telemedicine. Take a listen as Dr. Zubrow discusses the theory behind remote ICU care, reviews models of care delivery, and dives into the medical literature involving ICU telemedicine.
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Why Telemedicine In ICU?
- Only 4% of hospitals in the US have in house overnight ICU coverage
- Rates of physician burnout is correlated to number of night shifts
- Increase patient population without a corresponding increase in Intensivists
- 74% of consumers are open to virtual doctors visits
What are the models telemedicine?
- Decentralized models – equipment to push electronic information to any physician
- Centralized models – with telenurses or teledoctors still in contact with admitting doctors
- “Closed” systems with covering team which can consist of ICU doctors, nurses, physicians assistants, nurse practitioners and/or pharmacists with either on demand (initiated by hospital) or scheduled interactions with the ability to continuously monitor patients.
How to Integrate into an existing practice?
- It can’t just be about putting in the technology!
- You must have support from senior leadership, buy in from all the affected groups and processes in place
- Need people – ”proceduralists” to intubate, place central lines, chest decompression
- Engagement from nurses and staff to actively use the system and interact
- Process – Protocols for treatments, sedations, standardization of drips
- Technology – dedicated encrypted lines, ultrasound, robots
Suggested Readings
- Lilly CM, Zubrow MT, Kempner KK, et al. Critical Care Telemedicine: Evolution and State of the Art. Crit Care Med 2014; 42:2429-2436. [PubMed]
- Lilly CM, McLaughlin JM, Zhao H, et al. A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care. Chest 2014; 145(3):500-507. [PubMed]
- McCambridge M, Jones K, Paxton H, et al. Association of Health Information Technology and Teleintensivist Coverage With Decreased Mortality and Ventilator Use in Critically Ill Patients. Arch Intern Med 2010;170(7):648-653. [PubMed]
