Not too long ago, Rush Memorial Hospital in Rushville, Indiana, did not have the capability to staff an ICU 24/7. Physicians and nurses were only able to provide ICU care on a part-time basis.

THE PROBLEM

This was something staff was looking into even before COVID, as they were thinking about what was best for their patients and their families when it comes to being admitted to the hospital.

In addition, surgery staff was top of mind – without having an ICU, surgeons were less likely to perform certain surgeries. When COVID came and staff was faced with the inability to transfer, they knew it was time to do something different.

"Creating a traditional, in-person ICU wasn't feasible for us because our hospitalists had a seven-day rotation and being a small rural hospital we only had two of them on staff," said Carrie Tressler, RN, vice president of nursing at Rush Memorial Hospital. "Adding a full-time critical care intensivist just didn't make sense for us.

"Moreover, trying to have the two hospitalists perform the intensive critical care at all hours during their shift would greatly increase the likelihood of burnout," she added.

PROPOSAL

Rush Memorial brought in vendor Access TeleCare to implement a two-bed, virtual ICU.

"We wanted to be able to open our ICU and have available the intensivist/pulmonologist coverage our patients needed," Tressler explained. "The added support would enable our hospitalists to focus on caring for higher-acuity patients, without having to transfer them to another facility."

MEETING THE CHALLENGE

The virtual ICU enables the virtual providers to interact with patients via a telemedicine cart. The HITRUST-certified telemedicine carts have full zoom-tilt cameras and integrated stethoscopes, so the virtual providers are able to get all the inputs they need to care for the patient adequately.

"The virtual ICU providers are available overnight and take care of all the admits; in the morning, they transition those patients to our hospitalists and then they are available for any guidance or questions our on-site staff may have regarding those patients during the day when they're rounding," Tressler noted.

"The virtual ICU providers also work closely with our emergency physicians and anesthesiologists for those hands-on procedures so care continuity is smooth as they transitioned to the virtual ICU," she continued.

Access TeleCare's providers also work closely with Rush Memorial nursing staff on education and training on how to operate the ICU and always are there to answer questions and provide guidance.

The hospital uses Cerner for its electronic health record. The virtual physicians can access the EHR to adequately care for the patients and make all necessary documentation.

RESULTS

Since deploying its virtual ICU, Rush Memorial has seen an increase in surgeries. The virtual ICU has enabled surgeons to feel comfortable performing more surgeries, knowing they had available to them the clinical expertise to care for those patients in recovery in the ICU.

"We have seen a decrease in our transfers," Tressler reported. "By enabling our care teams to care for more patients post-surgery in the ICU, we have been able to reduce the number of transfers to other facilities.

"Also, we have improved our patient experience," she continued. "A good portion of our patients are older and in the Medicare population, which we were concerned would be a problem with virtual care. However, the feedback we've received has been overwhelmingly positive and they've enjoyed the virtual care."

Having on-site nurses involved in the virtual visits as well as the hospitalists rounding on the patients has been helpful to the patient experience as it keeps a human element involved, she added.

"Moreover, the fact that having this virtual ICU in place has saved many patients and their families from having to transfer to other facilities that are more than 60 miles away is a reason patients are very happy to have the virtual care," she said.

ADVICE FOR OTHERS

The virtual ICU has enabled Rush Memorial surgeons to feel comfortable performing more surgeries, knowing there is the clinical expertise to care for those patients in recovery in the ICU.

"If you are considering implementing a technology like this to provide needed coverage in your hospital, I highly recommend it," Tressler advised. "Just be sure you are finding a vendor that has done it before, that has the experience and expertise to help you set it up appropriately, as well as the flexibility to work with your existing workflows."

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