Tele-ICU helps 'sickest of the sick' across state

It’s the middle of the night but Dee Ford, M.D., is wide awake. Lives literally depend on it.

Her patients, whom she calls “the sickest of the sick,” aren’t in the hospital where she works at the Medical University of South Carolina. They’re not even in the same city. They’re miles away in a pair of smaller hospitals that provide good care but have fewer resources than MUSC: Palmetto Health Tuomey in Sumter and AnMed Health in Anderson. 

The distance is no obstacle thanks to tele-ICU, or tele-intensive care unit treatment, which links patients at these hospitals to full-time expert care via video and data streams. “It’s a much more intensive type of oversight than they’d get without it,” Ford says.

By the end of 2016, MUSC will be monitoring 120 ICU patients at a time across the state. Ford says it’s part of a national trend. “It’s estimated that as many as 10 percent of all ICU patients in the U.S. are being monitored by a tele-ICU.” 

Ford is the first MUSC doctor to participate in tele-ICU, which involves treating patients remotely with the help of technology. With tele-ICU’s strong track record – one report suggests this type of program can reduce patient deaths by as much as 40 percent - she won’t be the last. “There are five MUSC doctors in the pipeline besides me,” the critical care specialist says.

There are also several other hospitals in MUSC’s tele-ICU pipeline, including Kershaw Health in Camden, Carolina Pines Regional Medical Center in Hartsville and Springs Memorial Hospital in Lancaster. 

Tele-ICU is part of what some analysts see as the wave of the future: telehealth in a wide range of health areas, covering everything from psychiatry to stroke treatment to nutrition counseling. MUSC has a thriving Center for Telehealth that has collaborated with organizations around the state to establish the South Carolina Telehealth Alliance to encourage partnerships between large regional hospitals and their smaller neighbors. Getting tele-ICU up and running has been one of the center’s main goals.

Ford, who directs the Medical Intensive Care Unit at MUSC, says there’s a good reason for that. “Tele-ICU can help solve a common problem. In a community hospital, there’s often no physician at night. There might be a hospitalist or one person who’s trying to hold the whole place together.”

Nurses are left to try to make decisions on their own or wake up a doctor who may not be happy about that. “Tele-ICU takes that whole issue off the table because there’s always a doctor whose only job is to be there, monitoring the patients,” Ford says.

During a tele-ICU shift, which Ford takes in addition to treating patients at MUSC and serving as an associate professor of medicine, she sits in a room surrounded by monitors delivering a constant stream of data and images from her remote patients. 

It may sound cold or overwhelming to some people, but Ford says it’s actually liberating. She can temporarily put aside the billing and forms that are normally part of her job and focus on her tele-ICU patients. Even better, she says, the patients and their loved ones like it.

“It’s very well received, especially by families, because the communication is very good,” Ford says. There are cameras and video screens that let her talk directly with patients, family members and hospital staff. 

“Families are really grateful to know there’s an additional support team there in case something goes wrong. It increases their confidence and comfort.”

MUSC’s tele-ICU program is part of the Advanced ICU Care network, the country’s largest tele-intensive care provider. The partnership with AICU, which includes a new operation center at MUSC, was funded by an allocation from the state. 

Emily Warr, a nurse who also serves as program coordinator for tele-ICU at MUSC, says MUSC nurses will soon join the team. “They’ll come from the inpatient intensive care units here at MUSC. They’ll still work at the bedside, but they’ll also start to have some time in the operation center.”

Warr says tele-ICU patients also have an asset that they won’t see but clearly benefit from. “There are algorithms built into the technology we use. They can predict the decline of patients sooner than I might be able to at the bedside.”

That gives doctors and nurses time to take steps to prevent problems. “It’s early detection software I’d certainly want my loved ones to have access to if they were in the hospital,” Warr says. 

Ford says the algorithms are part of tele-ICU’s emphasis on preventing problems in community hospitals instead of reacting to them after they arise. That leads to healthier patients and fewer transfers to larger hospitals, saving lives and lowering health care costs. “MUSC is in the business of trying to meet the health care needs of our state,” Ford says. “This is another way we’re doing that.”