The future of intensive care: Tele-ICU
NELLIS AIR FORCE BASE, Nev. — For Airmen working in a hospital’s intensive care unit, getting a second opinion from an experienced physician serves as an invaluable commodity.
Airmen at the Mike O’Callaghan Federal Medical Center here will have that opportunity thanks to a partnership with Veteran Affairs to bring the first Tele-ICU to the Critical Care Unit, improving the quality of patient care.
“The Tele-ICU is a way to use an audio and visual computer network to fill gaps in coverage and offer a second set of eyes to intensive care units,” said Matt Goede, Veterans Affairs VISN 23 Regional Tele-ICU associate medical director. “There’s a central hub in Minneapolis, with nurses and physicians that monitor patients with rooms wired with a video camera, video monitor, speakers and microphones so that they can teleconference in if necessary.”
From the remote central hub, doctors and nurses can observe medical data to assist physicians and nurses that are on-site with patients in real time.
“We will have access to all patient monitoring equipment data that are in the ICU,” said Kay Clutter, Veteran Affairs operations director. “We can see wave forms that come across, we see hemodynamics that come across and basically see everything that the on-site staff see. We can observe when a patient is starting to decline or not look so well, and sometimes we’ll see it before the bedside physicians because of alerts we get on that patient.
“At that point in time, we’re able to camera into the room, ring the bell and take a look at the patient with our high definition cameras. With our view of the patient, we’re able to act as a decision support tool for the physician on-site if requested.”
This support tool offers all those working in the Critical Care Unit new options to improve patient care.
“Tele-ICU nurses can focus on multiple patients, specifically stable patients, so nurses on-site can focus on a patient that isn’t doing as well,” said Clutter. “For a site like this that has residents, it gives them someone 24/7 who’s a certified critical care physician. Residents can talk with them, discuss the patients and discuss the care.”
With this new system providing physicians the ability to increase care for patients, the Tele-ICU lines up with what the Air Force Medical Service is attempting to accomplish on multiple platforms.
“The Air Force Medical Service is now on a journey to become a high reliability organization, which is a commitment to eliminate preventable harm and improve patient safety throughout the enterprise,” said Air Force Col. Patrick Danaher, Air Force Medical Operations Agency chief internal medicine consultant. “The primary goals are to ensure zero harm and to provide the highest quality care to our patients. We have doctors, nurses and technicians that have to deploy downrange, often coming from ICUs, to take care of critically ill patients.
“We need them to be providing high quality care to a diversity of acutely ill patients while they’re here so they’re clinically current and ready to deploy. The Tele-ICU compliments both of these missions perfectly. It allows Air Force medics to benefit from the ability to take care of the patients with the expertise from the Tele-ICU.”
With this new technology being a multifaceted tool designed not only increase patient care, but also physician expertise, seeing it in a downrange environment is a very real possibility.
“The best way to describe it is similar to how we use remotely piloted aircrafts,” said Air Force Col. Charles Tedder, Air Combat Command chief medical modernization and plans. “The downrange team launches the aircraft, then hands off to the team who handles the mission, and when it comes to landing that team hands it back. The hope for this is that once it’s a proven technology, we can supplement the care that is offered in downrange facilities, and forward operating bases that only have a handful of doctors and nurses. They can hand-off a stabilized patient to the remote capability that can monitor the patient allowing that FOB to concentrate on other patients, increasing our holding capability.”
To eventually move this technology to more bases and FOBs, AFMS partnered with the VA in a Department of Defense/VA Sharing Initiative called the Joint Incentive Fund. The JIF was established under Section 721 of the Fiscal Year 2003 National Defense Authorization Act to provide seed money and incentives for innovative DoD/VA joint sharing initiatives to recapture, improve quality and drive cost savings at facilities, regional and national levels.
JIF is only designated for use by the Veterans Health Administration (VHA) and Defense Health Agency entities for direct medial sharing initiatives or for services or systems that facilitate DoD/VA interoperability.
Five of the existing Air Force ICU sites are tied to MOFMC. The base acts as a perfect place to start the program.
“This is the perfect experiment for us to figure out how those patient flow, and all those things that have to be done, so that when we get down range we will know just how it will work,” said McCarty.
The VA team stated that they were excited to be partnering with the Air Force on this new endeavor.
The program will look to become operational in April 2017, and act as a quality improvement project on how to increase patient care and how to better the technology for future use.
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