Parkview Health Case Study

Providing 24/7 ICU patient monitoring and supporting local care initiatives through tele-intensivist program

Situation
Studies show that care by intensivists (critical care medicine physicians) greatly improves patient care in the ICU. One study found that high-intensity ICU physician staffing (in which all care is directed by intensivists) was associated with lower hospital and ICU mortality rates and reduced hospital and ICU length of stay¹.

The Leapfrog Group, a consortium of Fortune 500 employers that promotes the quality and safety of healthcare, has identified intensivist staffing as one of its "safety standards." According to Leapfrog, more than 54,000 ICU deaths could be avoided if this standard were implemented.

However, with just around 6,000 intensivists in the U.S., these specialized physicians are in high demand. By 2010, demand for intensivists is expected to outstrip supply, and this shortfall will continue to worsen given the aging U.S. population. Given these supply and demand characteristics, many hospitals ― particularly those in more rural communities ― are finding it difficult to recruit intensivists for their ICUs. Others with on-site intensivists are looking at ways to best leverage these scarce specialists to provide the highest level of care for their patients.

Solution
Background
Several years ago, Parkview Health implemented an eICU® program, which utilized telemedicine technology to connect ICU patients to a centralized monitoring facility staffed by Parkview intensivists. The technology was developed to provide the best possible care in the ICU and leverage scarce resources. But even so, with the nationwide shortage of intensivists, Parkview ― like many other hospitals ― found it difficult to recruit as many intensivists as it needed for complete coverage.
Providing 24/7 intensivist care

The hospital system turned to Advanced ICU Care, which provides continuous ICU patient monitoring by board-certified intensivists and critical care nurses. Using eICU telemedicine technology, Advanced ICU Care's critical care staff, located in St. Louis, Missouri, monitors ICU patients in hospitals hundreds of miles away. By using Advanced ICU Care's program in addition to its own intensivists, Parkview was able to extend its eICU services to patients seven days a week, enhancing patient care and safety, without hiring additional intensivists.

Expanding in-patient physician coverage
Taking the program a step further, Parkview now utilizes Advanced ICU Care's program exclusively. Parkview designed an intensivist-hospitalist program at the bedside to care for its ICU patients, increasing the amount of bedside support these specialist physicians provide and expanding their in-patient coverage. (Hospitalists are physicians dedicated solely to treating hospitalized patients). Part of this local program, Advanced ICU Care's intensivists and critical care nurses now provide around-the-clock care and monitoring for Parkview's 45 ICU beds, supporting the local physicians and nurses. In turn, this enables Parkview intensivists to spend their time at the patient's bedside, facilitating the system's local care initiative aimed at expanding in-patient physician care coverage in the ICU.

"This collaboration delivers the best possible care for our patients, providing an extra layer of care with 24/7 remote monitoring as well as expanded care at the bedside by a team of specialists." -- Julia Walker, BSN, RN, CCRN, hospitalist program manager, Parkview Health

Supporting quality improvement initiatives
The program signifies the system's commitment to providing excellent care by expanding patient access to specialist care, either at the bedside or through telemedicine technology. The program also helps to support continuous quality improvement efforts by establishing and ensuring best care practices and tracking results - features critically important to hospitals seeking to provide the highest quality care for their patients.

About Advanced ICU Care
Through experienced clinicians, supported by cutting-edge telemedicine technology, and a process improvement program, Advanced ICU Care provides continuous ICU patient monitoring and improved care and safety outcomes to critically ill patients across the country. Hospital ICUs are linked with Advanced ICU Care's eICU Operations Center in St. Louis, Missouri through a technology platform developed by VISICU, allowing Advanced ICU Care's board-certified intensivists and critical care nurses to monitor hospital ICU patients from a central location. Founded to improve access to critical care expertise, deliver best practices to patients by leveraging telemedicine technology, and establish intensivists as the standard of care, the Advanced ICU Care program delivers around-the-clock critical care specialists, dramatically improving patient care.

About Parkview Health
Parkview Health is a not-for-profit family of hospitals, physician clinics, long-term care facilities, home health and hospice, laboratory, EMS, research center, and fitness centers serving a 15 county region in Indiana and Ohio. The health system is also home to the Samaritan Flight Program and the Parkview Heart Institute. Parkview Hospital has a nationally verified Level II Adult & Pediatric Trauma Center, certified stroke center, accredited comprehensive cancer center, and accredited chest pain center. Employing more than 6,000 full and part-time staff, Parkview Health's mission is to provide trusted quality care and to improve the health of the communities it serves.

^{1 Journal of the American Medical Association, 2002;288:2151-2162
eICU is a registered trademark of Visicu, Inc.}