SCCM Resource Library-National Emergency Tele-Critical Care Network (NETCCN)

Video Transcription

Hello, my name is Ben Scott. I am an associate professor of anesthesiology at the University of Colorado School of Medicine.  I'm also outgoing chair of the SCCM Telecritical Care Committee and still a member this year. I am going to talk to you today in place of Colonel Jeremy Pamplin about the growth and  development of the National Emergency Critical Care Network. I have no disclosures for this talk.  I just want to lead with this slide to make an important point, which is that the National Emergency Telecritical Care Network is the end result of a huge amount of work and major  commitments from numerous organizations, individuals, government agencies, and you can see by reading  through this list that this has truly been a national effort, and one of the most amazing things about it has been how everybody's come together to pull in the same direction and  to try to coordinate and collaborate, and I'm really proud to have been a part of it. I think this audience is probably aware of this, but it's important to note that over  half of all U.S. counties currently lack access to intensive care unit beds and to trained critical care clinicians.  The COVID-19 pandemic has obviously magnified this issue in stark terms. We know that telecritical care can expand both the capability and the capacity of local  caregivers who don't have access to expertise on a daily basis, and telecritical care has  been demonstrated in the past to improve outcomes in both rural and urban medical centers when there are no expert clinicians available.  In recognition of this problem, SCCM has been involved since prior to the COVID pandemic in several important strategic initiatives to try to address this shortage of critical  care expertise. In 2018, two proposals, strategic proposals, were submitted to SCCM Council, the first  to create a task force that would study and make recommendations on how technology and specifically telecritical care could be used in an emergency or disaster situation, and  then a second proposal, which I've already discussed, was also submitted for the creation of a national collaborative telecritical care network designed to improve communication  and discussion between different stakeholders in national telecritical care. In 2019, these proposals were approved by SCCM and the task forces got to work, but  in early 2020, obviously, COVID-19 emerged and suddenly both task forces found themselves thrust into a rapid development phase.  Obviously, we were not the only ones to recognize the potential impact of telecritical care, in particular, for expansion of resources in terms of treating COVID-19.  This is just a scattering of relevant articles and descriptions of programs that expanded their services using telecritical care.  Many of you are probably familiar with the pyramid diagram released by SCCM early in the COVID-19 pandemic that outlined the ways in which a small number of critical care experts  could provide support and guidance to a larger number of clinicians forced to operate outside  their normal scope of practice in response to the resource strains caused by the COVID-19 pandemic.  The telecritical care model is similar, which recognizes that a small number of expert clinicians  using telecritical care technologies can serve as a powerful force multiplier, allowing a smaller number of experts to provide guidance for a large number of clinicians through the  creation of numerous virtual wards. And as you can see in the diagram here, the idea of Netson is to provide a rapidly deployable  lightweight solution that allows the establishment of virtual wards, whether they be in an ad  hoc hospital like a gymnasium, in an existing hospital ward, or in a small ICU, or potentially in any area where there needs to be rapid deployment of critical care.  Netson was developed through a unique competitive process in which the Medical Technologies  Enterprise Consortium, or MTEC, oversaw competition between multiple teams through a series of rapid sprints.  Each team was tasked with developing a lightweight, deployable application and platform which would allow for user registration, virtual patient triage, synchronous and asynchronous  communications, care documentation, data collection, and reporting. After three rounds of competition, three teams, Avell, Deloitte, and Omnicure Geneva, were  selected to continue development of their platforms and to test them in real world situations.  A fourth team, the Expressions Network, was tasked with a separate job of creating a dashboard  and command system, which you see a snapshot of here, to document the Netson deployments. Although initial uptake was slow, following development of a website and targeted outreach  by the Department of Defense, the ASPR, and the Society of Critical Care Medicine, requests for help from Netson did start to flow in.  Often these were from rural and critical access hospitals, and not surprisingly, the volume of requests tended to fluctuate with surges in COVID volume.  As you can see in this table, following the Delta and Omicron surges, nearly 110 requests  for help were submitted to Netson, and about half of those ended up going live in 14 states.  It's important to note that the average time to starting support in these cases was quite long compared to our initial goals, with an average of about 32 days.  As of my recording in mid-February, you can see that there have been 61 total hospitals or organizations that have used Netson, 24 are still currently active.  About half of those hospitals have been critical access hospitals. You can also see that we have been involved in providing care to United States territories and one non-US country.  There have been a total of 5,434 patient care encounters to date. Netson has been able to demonstrate some very important early successes.  Despite what I mentioned before about the average length of time to deployment, once the decision is made to proceed with Netson, deployment has been very rapid.  The software platform is available within hours, doesn't require any additional hardware. Clinicians and patients have been able to use and adopt the technology in hours to days,  and thousands of live video messages and other files have been exchanged thus far. Netson has been able to fill in clinical gaps by providing expertise in specific cases  where none was locally available. It has been also used to monitor over 200 patient interactions for patients who are  at home, helping to avoid hospital admissions, and there was at least one case where Netson  turned out to be the only technology available when a hospital's primary communication system failed and they had to rely on it.  Netson has also helped in ways that are similar to what's been reported for telecritical care for a long time, including providing backup support for telemetry services.  Users have noted that Netson helped relieve anxiety and improve their feelings of task saturation and exhaustion and burnout.  It's been used to provide a second set of eyes and a second set of brains to assist with local decision making.  It's been used to facilitate palliative care discussions and improve family presence at the bedside.  It was used by an EMS service as part of their monitoring program to monitor patients receiving monoclonal antibodies, and it's just helped in general to provide a sense of support,  and I think everybody would like to see outcome data and wants to know how mortality has benefited  and in what ways concrete outcomes have been changed, but it's important to recognize that those kinds of changes require time.  They require large patient volumes to demonstrate effects, and what we can say with certainty  is that Netson has provided the sense of support and backup that it was intended to for many clinicians across the country over the last year and a half.  These Netson deployments also reinforce several important lessons. First and foremost, even with COVID-19 waivers and emergency declarations, licensure and  credentialing remain huge barriers. Netson partnered with ProviderBridge to try to streamline the onboarding process for virtual  staff, and that helped somewhat, but there was still significant amount of reluctance  to open up the credentialing process to outsiders on the part of many of these hospital administrations.  It worked better when we worked through trusted intermediaries and were able to use local networks.  We noticed that oftentimes customers may have inquired about help early on in the pandemic and then sometimes decided not to go forward until later when they needed help, and the  second time around, the process was much faster. We also recognize that you can't help everyone.  Many requests came in, but then were never really followed up by any actionable decisions, and so we have had to develop a process for triage and for trying to figure out who needs  help the most since we can't help everyone. Additional barriers included cultural barriers, setting expectations, establishing trust.  Technological barriers were rarely the main sticking point, but particularly integration of the electronic medical record proved to be challenging, and then policy barriers,  as discussed, were probably the most important, particularly with licensure and credentialing.  Other characteristics of success or failure worth noting were that having a pre-established  vetting process was tremendously important, and deployments were most likely to be successful  when there was a clearly identified need and when leadership, especially at the local level, was effective in engaging all the key stakeholders.  When expectations or mission was not aligned, and in particular when programs were 100% driven by administrative requests and didn't have much staff presence at the training or at  the decision-making process, and also when organizations did not have any physician involvement, the deployments were less likely to be successful.  It's important to note that one thing that wasn't clear was whether using a nurse navigator or other administrative navigator as part of the Della Critical Care team versus a direct  to expert communication pathway was more effective. The jury's still out on that, and we suspect that probably the answer is that some use  cases are more likely to benefit from a navigator, and in other cases, it might be better to offer direct to expert communication.  We did receive a significant amount of customer feedback, most of which was inspiring and I think indicated that the program overall was well-received by its customers.  It remains to be seen whether COVID-19 is finally subsiding or if we are just in another lull between waves, but an important question is what's next for Netson?  The answer to that question really lies in the concept of the virtual hospital. In the future, Netson will be incorporating improved data sharing, device interoperability,  remote control of things like ventilators and infusion pumps, and improved predictive  analytics and logistics to better match resource allocation with resource strain, and the general  idea is to provide true hospital-like capabilities anywhere in the world at a moment's notice.  It's really important also to point out that despite the overwhelming impact that COVID-19 has had on the development of Netson, it was really designed as an all-hazards approach,  and its utility is not limited to COVID-19, but has a lot to offer in terms of responses to all manner of resource strain and future disasters.  The other thing that's crucially important to recognize is that in order to be successful and to have long-term sustainability, these tools need to be used on a regular basis.  So the future of Netson lies in an expanded infrastructure, further development of the network capability in a sense of being able to hand off communications from one center  to another, and really to provide this support anytime it's needed within minutes. And COVID-19 has been a tremendous proving ground, there's a long way to go, but we're  all very proud of the success that we've had, and I just want to give a quick thank you to everyone, the hundreds of people that have been involved in this project for the last  two years. It's been a real team effort, and as I said at the beginning, I'm proud to have been a part of it. Thank you very much. And I'm happy to take questions if time allows.  Thank you very much. Please let me know if you're interested in participating.

Video Summary

The National Emergency Telecritical Care Network (Netson) has been developed as a response to the shortage of critical care expertise in the US. The COVID-19 pandemic has further emphasized the need for telecritical care to expand resources for treating the virus. Netson has been able to rapidly deploy its virtual wards in various locations, providing support and guidance to local caregivers. Over 60 hospitals and organizations have used Netson, with thousands of patient care encounters recorded. The success of Netson highlights the importance of regular use and future development to ensure long-term sustainability and preparedness for future disasters.

Asset Subtitle

Administration, 2022

Asset Caption

In this flipped-classroom session, an expert panel will discuss aspects of tele-critical care such as policy and governance, the National Emergency Tele-Critical Care Network (NETCCN), multiorganizational collaborative networks, data analytics, and quality metrics. Legal and licensing barriers to tele-critical care practice and the workings of a cloud-based virtual critical care ward will also be covered.

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Telemedicine eICU

Year 2022

Keywords

National Emergency Telecritical Care Network

Netson

shortage of critical care expertise

telecritical care

COVID-19 pandemic

	Society of Critical Care Medicine 500 Midway Drive Mount Prospect, IL 60056 USA Phone: +1 847 827-6888 Fax: +1 847 439-7226 Email: support@sccm.org	Contact Us About SCCM Newsroom Advertising & Sponsorship DONATE	MySCCM LearnICU Patients & Families Surviving Sepsis Campaign Critical Care Societies Collaborative	GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. \| Privacy Statement \| Terms & Conditions The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.