The ICU and its workforce play a central role in health systems’ – and patients’ – overall health, with the department accounting for 10 percent of total in-patient beds and 30 percent of in-patient costs. Six million Americans are admitted to the ICU each year. At the same time, critical care is taking a big hit from the physician shortage, with a projected short-fall of up to 22 percent by 2020. Compounding this, ICUs are facing increased cost pressure and scrutiny with regard to patient safety and quality. In ICUs, serious errors occur in 150 of every 1,000 patients and adverse events occur in 81 out of every 1,000 patients.
The good news is that 45 percent of these adverse events are preventable. With the right tools and staffing strategies, hospitals can better utilize the physicians they have while improving the quality of care in their critical care units. Here are some methods to help hospitals and health systems address these challenges:
- Introduce more intensivists – Driven by the mounting pressures of health reform and the physician shortage, we’re seeing more and more hospitalists, emergency department physicians, physicians’ assistants and nurse practitioners working in critical care settings. If these clinicians are responsible for patients throughout the hospital, including patients in the ICU, there needs to be strategies in place to ensure adequate coverage of the most acutely ill patients. For example, the ICU can lean on intensivists – internists specialized in critical care. Research indicates that care managed by intensivists can reduce patient mortality rates and the length of ICU patient stays. Offering the highest level of care to the sickest patients by adding a 24/7 intensive care physician model ensures that these staffing approaches don’t impact the quality and consistency of patient care.
- Remote ICU monitoring and “eICUs” – Many hospitals do not have the resources necessary to employ a 24/7 intensive care physician model. Therefore, tools such as the ‘eICU’ have been developed to empower intensivists and other clinicians with the ability to care for critical care patients from remote locations and maintain the 24/7 staffing model. The ‘eICU’ and other forms of telemedicine have been used in critical care for a number of years, and have become an important part of how care is delivered in the ICU. In the years ahead as more patients come into the critical care units, with less reimbursement and fewer physicians, tools such as telemedicine will become increasingly important to improve care coordination, patient care and patient safety in a staff constrained environment.
- Empowering clinicians with mobility – The future of caring for the growing number of critical care patients will require tools that provide clinicians with instant access to relevant live and historic patient information, delivered from a variety of underlying information sources. Mobile applications have the ability to provide this data, empowering critical care physicians, regardless of their location, to proactively monitor and immediately respond to changes in a patient’s condition, improving the quality of patient care in a cost-effective manner. Additionally, mobility extends intensivist coverage to address the staffing challenges of the ICU, especially in health systems that aren’t able to deploy a high-intensivist staffing model, or remote hospitals that may not have access to fellowship trained critical care physicians.
I have experienced a spectrum of critical care settings, including in austere locations such as Iraq and Afghanistan, as well as in some of the best equipped hospitals in the developed world. I truly believe that mobile applications can address the shortage of critical care physicians, while improving the quality of care that can be provided for our sickest patients. In the near future, we are going to see more mobile applications being used in critical care settings. I am excited to see how they benefit patient care and quality.