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General FAQs
Follow the links below to navigate directly to specific questions.
- What is telemedicine?
- What is a virtual eICU?
- What is an intensivist?
- Why was Advanced ICU Care formed?
- What technology does Advanced ICU Care use?
- What benefits related to quality improvement have been achieved by the virtual management of ICU patients?
- Who does procedures/emergency procedures if they are needed?
- What impact will Advanced ICU Care's program have on private attending physicians at our hospital?
- How are the costs structured for the Advanced ICU Care program?
- How can a participating hospital benefit economically in view of the capital and annual operating costs of the Advanced ICU Care program?
- Can an individual hospital purchase and operate the VISICU technology platform itself?
- What factors are key to the success of the Advanced ICU Care Program?
- Will the Advanced ICU Care program make my hospital Leapfrog compliant?
- In summary, what benefits can be expected from the Advanced ICU Care program?
What is telemedicine?
Telemedicine is a technology that applies audio and video applications to patient and healthcare givers' interactions. This technology is used for the evaluation of specific problems to enhance diagnosis and treatment decisions, particularly by bringing medical expertise to an area that may lack it, e.g., dermatology to a remote setting. This is typically an episodic encounter, scheduled in advance and of a non-urgent nature.
What is a virtual eICU®?
Virtual eICU®, a registered trademark of VISICU, Inc., is a term used to describe telemedicine technology that combines clinical management software with virtual-care tools - including patient data and video feeds - to allow intensivists and critical care nurses to virtually care for patients in hospital ICUs. Data is collected on a continuous basis and trends in patient status are collated and responded to in real time. This allows for urgent and emergent issues to be addressed immediately. The eICU technology platform was developed by VISICU to help leverage scarce intensivist resources and to virtually direct patient care. Virtual eICU® centers are staffed by intensivists and critical care nurses who can monitor and care for a large number of ICU patients in multiple hospital locations, thousands of miles away.
What is an intensivist?
Intensivists are physicians who have received training in critical care beyond their primary residency. They initially train in and receive board certification in a specific medical specialty, such as surgery, internal medicine, pediatrics or anesthesiology. Subsequently, they train in and obtain a subspecialty certification specifically in critical care medicine. A unique feature of the training is collaboration with others to deliver optimized patient care. Intensivists deliver care in a hospital's intensive care unit (ICU), partnering with critical care team members including other consultant physicians, critical care nurses, pharmacists and respiratory therapists. They are generally the team leader, facilitating all members to meet the patient's complex needs. They are specially trained on all the organ systems, as well as the medications, procedures and technology specific to the treatment of critically ill patients. They also help to set policies, develop protocols and facilitate communication within the ICU.Studies show that care by intensivists greatly improves the quality of care in the ICU. According to The Leapfrog Group, which has identified intensivist staffing as one of its "safety standards," more than 54,000 ICU deaths could be avoided if this standard were implemented.
Why was Advanced ICU Care formed?
The management and medical staff of many community hospitals have experienced the difficulty and frustration of attempting to recruit a sufficient number of intensivists to staff their ICUs. The difficulty in recruiting intensivists to many community hospitals is due to: the nationwide shortage of critical care medicine physicians; the abundance of opportunities in major metropolitan areas where many of these physicians have trained; and the reluctance of some intensivists to practice in a hospital without high acuity and volume.To address these challenges, Advanced ICU Care was formed. The company delivers intensivist expertise to ICUs through the use of sophisticated clinical management and communications technology, along with a process improvement program.
What technology does Advanced ICU Care use?
The technology platform was developed by VISICU, a Baltimore-based company which has been acquired by Royal Philips Electronics. VISICU's first virtual eICU® facility was installed at Sentara Health System in Norfolk, Virginia in 2000.
This virtual eICU® technology combines clinical management software with patient data and real-time video feeds, enabling the virtual care and monitoring of critically ill patients. The technology has proven itself even over long distances, with the United States military monitoring a virtual eICU® in Guam from an eICU facility in Hawaii, a distance of 3,000 miles.
Part of the virtual eICU® technology platform is the eCareManager™, a dashboard view of key patient information such as vital signs, physiologic data, medications, lab results and more ― giving virtual clinicians the data they need to provide patient care. Virtual care tools, such as cameras and videoconferencing, allow virtual eICU® physicians and nurses to see and communicate directly with patients, families and onsite clinicians. The system also provides automated alerts, which identify potential patient problems and allow physicians to intervene earlier.
Advanced ICU Care's virtual eICU® Operations Center, located in St. Louis, is staffed by intensivists and critical care nurses who monitor patients throughout the country.
What benefits related to quality improvement have been achieved by the virtual management of ICU patients?
The clinical benefits of having intensivist expertise in ICUs are well documented in the medical literature.1 Virtual management of ICU patients also provides significant clinical benefits to healthcare organizations. These include reductions in patient mortality, reductions in both ICU and post-ICU floor lengths of stay, and a reduction in the number of outliers. A study performed at a 10-bed surgical ICU in an academic-affiliated community hospital determined that with virtual monitoring of ICU patients, severity adjusted hospital mortality decreased, on average, by 30 percent, and the incidence of ICU complications decreased by 47 percent. In addition, ICU length of stay decreased by 32 percent.2
1. Pronovost, P.J., Angus, D.C., Dorman, T., et al, Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients, Journal of the American Medical Association 2002; Vol. 288, No. 17:2151-2162.
2. Rosenfeld, B.A., et al, Intensive Care Unit Telemedicine: Alternative Paradigm for providing Continuous Intensivist Care, Critical Care Medicine. 2000 Dec; 28(12):3945-3946.
Who does procedures/emergency procedures if they are needed?
All hospitals have processes in place to deal with common emergency procedures. These include dedicated in-house personnel (physician assistants, critical care nurse practitioners, house physicians, hospitalists, anesthesiology personnel and emergency department physicians) or specialty physicians on call from home (cardiologist for pacemakers, etc.). These processes remain in place, except that the call for the procedure would likely be initiated by the intensivist at the virtual eICU®, after discussion with the attending physician. If surgical evaluation is required, the process is the same - the virtual eICU® intensivist contacts the surgeon requested by the attending physician. Virtual eICU® intensivists coordinate these activities, maintaining the nurse at the bedside.
What impact will Advanced ICU Care's program have on private attending physicians at our hospital?
The system is designed to support local physicians and their patient care. There is no effect on their billing of professional fees. The attending physician maintains the authority to set the daily care plan. The role of Advanced ICU Care's program is to facilitate and expedite the local physician's care plan while enabling him or her to conduct his or her hospital/office practice more efficiently. Specific protocols for virtual eICU® intensivists are developed during implementation. A common practice is for virtual eICU® intensivists to field calls from the ICU at night and on weekends. Local physicians often discover that the number of calls interrupting their nights, office hours and operating room time declines dramatically.
How are the costs structured for the Advanced ICU Care program?
Advanced ICU Care's cost structure is based on a case rate, or per admission basis. This cost structure aligns closely with the hospital's cash flow. While there are some initial upfront costs, the actual capital requirements are minimal.
How can a participating hospital benefit economically in view of the capital and annual operating costs of the Advanced ICU Care program?
In addition to the significant benefits in the quality of patient care, the use of intensivists ― coupled with cutting-edge technology ― is a powerful tool for managing resource utilization. Cost savings are associated with a lower incidence of complications translating to reduced lengths of stay in the ICU and post-ICU floor, decrease in daily ancillary costs, lower nursing turnover rates and a decrease in nursing hours worked per patient day.
Additionally, the Advanced ICU Care Program supports instituting best practices and benchmarking actual performance compared to these practices.
Can an individual hospital purchase and operate the VISICU technology platform itself?
Due to the hardware and software costs of the virtual eICU® Operations Center, plus the need to staff the center with critical care medicine physicians, the VISICU software has only been acquired by large, typically regional, multihospital systems with in-house intensivists. Advanced ICU Care owns the virtual eICU® hardware and software license and distributes these costs among its participating hospitals, significantly reducing the costs to any one hospital. Additionally, Advanced ICU Care staffs the virtual eICU® Monitoring Center.
What factors are key to the success of the Advanced ICU Care Program?
The participation of key members of the medical staff, especially physicians most frequently using the ICU, in the decision-making process is important to success. Additionally, participation of the ICU nursing staff, ancillary departments and key medical staff members during implementation is very important. Advanced ICU Care and VISICU provide experienced clinical and technical staff to support hospital workgroups during this process.
Will the Advanced ICU Care program make my hospital Leapfrog compliant?
Implementing the Advanced ICU Care program may enable your hospital to become Leapfrog compliant. Hospitals that use intensivists via telemedicine achieve partial recognition by The Leapfrog Group. Depending on the additional ICU resources, the hospital may achieve full compliance.
In summary, what benefits can be expected from the Advanced ICU Care program?
The benefits of the program are summarized below:
- Expertise of experienced critical care medicine physicians and nurses available 24/7.
- Quality improvements projects initiated and tracked by Advanced ICU Care based on data collected by the software.
- Documented cost savings resulting from reduced length of stay and ancillary service use.
- Ability to benchmark severity-adjusted ICU performance against other Advanced ICU Care and VISICU hospitals.
- Reduced liability exposure resulting from the clinical guidance and documentation of the virtual eICU® program and the availability of intensivist expertise.
- Reduced ICU nursing turnover due to the immediate availability of intensivist support.
- Less "burnout" of physicians, e.g., pulmonologists, who provide support to the ICU.
- Improved attending physician lifestyle resulting from ICU intensivist coverage.
- Potential market differentiation by promoting the Advanced ICU Care program as a patient safety initiative that supports the hospital's commitment to quality care.
For additional information contact:
Scott Turner
Vice President - Sales & Marketing
Advanced ICU Care
999 Executive Parkway, Suite 320
St. Louis , Missouri 63141
Toll free: 866-394-6100
Local number: 314-514-6000