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KEY POINTS
The key to successful telemedicine is communication: telecommunication and interpersonal communication.
Telemedicine allows smaller hospitals to provide 24-hour continuity of care by an awake and alert board certified CCM physician, allowing access to an off-site intensivist at any time, day, or night.
Telemedicine allows hospitals to be compliant with current medical industry standards.
Improvements in delivery of care may lead to improved clinical and financial outcomes.
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INTRODUCTION: ADDRESSING A NEED
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Telemedicine was developed in the 1960s and 1970s by the US military and aerospace sectors by using information and communication technologies to provide medical care in remote areas.1 More recently, as telecommunication technologies have significantly advanced, telemedicine can help alleviate the shortage of physicians in certain specialties by allowing instant access to specialists who are not physically available at the location of the patient. Consequently, telemedicine, and in particular, tele-ICU, may help offset several well-known health care delivery challenges within the critical care community. These challenges include the following:
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A large deficit of board-certified intensivists staffing intensive care units (ICUs) during the day and, especially, at night. It is estimated that currently only one-third of ICU patients are cared for by board-certified critical care physicians.2,3 Halpern et al4 note that many intensivists are also certified in additional specialties and spend a portion of their time in those capacities, thereby reducing the time they spend in the ICU. Furthermore, staffing ICUs in smaller hospitals and those located in rural areas is very challenging. In smaller hospitals, the number of ICU beds is often not sufficient to support a dedicated on-site intensivist, and in rural hospitals, there may be limited access to critical care medicine (CCM) specialists due to issues related to commuting.
The aging population is increasing and although the number of trained critical physicians has increased in recent years, it is projected that by 2020 the demand for critical care physicians will exceed the supply.2
Another concern is the high cost of intensive care. Bartolini and King5 note that over six million of the sickest patients are treated in ICUs per year. This patient population has the highest rate of mortality and contributes the most in terms of the cost incurred in health care, consuming $107 billion dollars per year, which is 4.1% of the $2.6 trillion dollars spent on annual health care in the United States.
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To the extent that these challenges exist, research has shown that having an intensivist manage the care of ICU patients has significantly reduced mortality and length of stay (LOS) in the ICU.6,7 Furthermore, the Leapfrog Group, a voluntary employer-based coalition that advocates for improved quality, safety, and affordability in hospitals, notes that due to high mortality rates in ICUs, the quality of care in ICUs is of particular importance. The Leapfrog Group composed a safety standard indicating that intensivists ...