SCCM Resource Library-Tele-Critical Care: Reimagined Through Innovation and ICU Design

Video Transcription

the benefits and challenges of the many different telecommunication platforms that were used  by different organizations during the pandemic, and what did it take to onboard non-ICU clinicians  using the communication platforms, and what resources were needed, and what innovative workflows and communication protocols were enacted during that time.  And as you all know, COVID-19 accelerated the use of technology, and while this was very beneficial to our patients and to the healthcare organizations, it left us all in  a little bit of lurch, because not all of us became experts overnight with technology.  Some of us were very naive to advance technology, others grew up with technology, and then there  were experts. So there are very many different levels of expertise, but we didn't have the  time to learn it. It was thrust upon us because of COVID-19, and we had to learn the new platforms very rapidly.  So one of the concerns that many clinicians had was, what about the violation of HIPAA with some of these virtual platforms that they may or may not have used prior to the  pandemic? So at the very heart of the pandemic, the Office for Civil Rights at the Department  of Health and Human Services, who is responsible for enforcing certain regulations issued under  the Health Insurance Portability and Accountability Act of 1996, known as HIPAA, enacted the discretion  and decided not to impose penalties for non-compliance with the regulatory requirements under the  HIPAA rules against any covered healthcare provider in connection with the good faith provision of telehealth during the COVID-19 pandemic, which meant that any healthcare  provider could use audio or video communication technology to provide telehealth to their patients using any non-public facing remote communication product that was available to  them to communicate with the patients. So that alleviated anxiety for a lot of clinicians and healthcare organizations.  And the telehealth platform exploded. All of a sudden, we had tablets, we had online meetings that became our norms that virtually overnight, our world turned virtual for all  meetings. We had to get used to cameras everywhere, monitors, using platforms that we had never  seen or even heard of. And some of those platforms in the beginning crashed. But as more and more people got on those platforms, millions in fact, then the companies that ran those  platforms also realized they had to improve their platforms. So what were the influences of adoption of technology? Well, the COVID-19 pandemic, which  created a surge in ICU capacity. So now ICU patients are being cared for outside the traditional  ICU setting where there wasn't the traditional ICU room with everything in it, nicely situated  or spaced apart in places outside the hospitals and not even in the hospital, but in tents outside the hospital, in garages that suddenly became makeshift ICUs. So we needed to be  able to provide support outside the traditional ICU setting. So that influenced how quickly we adopted the use of technology. We needed to assess COVID ICU patients very rapidly  and give access to all healthcare providers, the same provision to them as it was to the regular ICU providers. So everyone could get on the same platform together, discuss the  goals of care for the patient, decrease their use of PPE when there was a nationwide shortage  and decrease their exposure to COVID-19. And if there was available monitors, headphones, cameras already in place, then it was much easier to adopt the technology.  So Boccolo and Associates in 2021 published on organizational telehealth adoption factors,  and they found the primary drivers were listed as organizational, technological, and social.  And then the secondary drivers included workflow integration, inadequate training, availability  of funding, and then what was the Wi-Fi quality like, what was availability of IT infrastructure.  So all of these secondary drivers were really determinants of adopting technology, adopting  telehealth. And then in 2021, in a publication, looking at what did naive healthcare providers  think about telemedicine prior to the deployment of telemedicine? What were their concerns? So you can see here listed on the left-hand side, the quality of audio or video would  be too poor. They wouldn't be able to hear their patient. What's the liability associated with telemedicine? They were very concerned about HIPAA, which we've just addressed in  the previous slide. And then what about families? They won't be able to access video services  due to lack of digital devices, or maybe Wi-Fi is not available in the area. These were very valid concerns prior to implementing telemedicine.  And then a model developed by Dr. Teresa Rincon, who has a vast experience with deploying  telemedicine, tele-ICUs, the INSTEP model. So Teresa developed this model with many components.  So you can see individual, the nature of the work, social aspects, leadership support, tools and resources. Are they easy to use? Is the technology easy to use? Is it easy  to set up? The external factors, and then the physical environment as well. These were all components of the INSTEP model. And what about the innovation during COVID-19? Well,  implementing tele-ICUs expanded their capacity outside the ICU, the usual boundaries for a tele-ICU. Video carts became commonplace everywhere, med-surg units, tele-units outside  the hospital and makeshift tents. All the workstations had to be equipped with tele-ICU technology so that every provider for that patient could get together and round together  virtually, discussing goals of care, incorporating the patients by giving them handheld devices  so they could speak to their loved ones without having to go into the room being exposed to  COVID-19. So addressing some of the concerns in that publication, we just discussed a couple of slides back. So a great example of rapidly deploying tele-critical care during COVID.  So physicians from three organizations listed here, UPMC, Mayo Clinic, and New York Presbyterian,  during the height of the pandemic in New York where they were inundated with thousands of COVID patients. In April 2020, they deployed rapidly a tele-ICU to address the immediate  needs of hospitals associated with the New York Presbyterian system in New York City. So how did they do it? They rapidly identified the need for the hospitals. They developed  the staffing models, the workflows. They decided who would provide continuous coverage  in the operations center 24 hours a day for seven days a week for the four weeks that they  deployed the system. They didn't really have to use much more technology than what they had.  They already had an infrastructure in place. And then they developed checklists for rounding so  that patients got the same care no matter who was rounding, who was the physician rounding the morning and the evening. So there was a standard that was followed at all times.  And it was a hybrid rounding, an on-demand model that they used. And what did they learn? One of the biggest things they demonstrated that advanced technology was not always needed.  Sometimes the phone was good enough. They didn't even need to go into the electronic medical record.  They had a lot of encounters conducted over the four weeks. And that sometimes you don't need additional technology. Just use what you have there,  but use it maybe in a different format than what you're used to.  In another example, thinking outside the box, leveraging medical students,  providing for assigned shifts per week in a tele-ICU unit. An example here is the Penn eAlert program. So they were able to provide support for the patients whilst in a learning,  calming environment that was conducive to them getting what they needed. And they provided  support for patients and for the physicians in the tele-ICU. So again, we know about the virtual  handovers and the consults using Zoom, MS Teams, FaceTime, other virtual platforms. Overnight,  we became virtual for all our teams. We became virtual teams. We had a lot more providers that  weren't normally looking after ICU patients. We developed three-way video calls to connect  so that anyone could click on the link that was sent to them when no matter where they were in  the hospital, outside the hospital, a different state, and provide immediate support and consult.  And then remote viewing during procedures, expert consultation.  So Dr. Reese at Advocate Health, providing support during codes, helping with the documentation,  providing support during procedure or timeout, procedural support, timeout,  central lines, arterial lines, and then managing ventilation of patients. So they had the same  care 24-7 so that they could get their RAS to go prior to the morning SBT so that more patients became eligible for SBT, decreased length of stay, decreased time on the ventilator.  And then being there for the patient. So there's the emotional support that tele-critical care EICUs can provide. The TCCRNs can spend time with patients in isolation,  reviewing photos of weddings with patients, being the calming voice in the middle of the night,  just spending time so that the patient knows that there's someone at the end of that screen or the  camera in their room that they can speak to immediately. And then being able to speak to the whole family and the patient together, either virtually or a patient and family being  in the same room. And really looking at x-rays and images at the same time. So it's the same  message given to all family members at once. So there's really clear, concise communication so that goals of care can be discussed by everyone together at the same time.  So really providing a second set of eyes for all. And we talked about ventilation management, support for agency and redeployed staff, timeout documentation, code documentation.  So what have we learned during the pandemic when it comes to leveraging technology? We can do it.  We can go from non-users of technology to pretty advanced users of technology pretty rapidly when  we have to. It's not always the best model to use, but we can do it. But we don't always need  advanced technology. Sometimes it's just a phone, a phone call. Sometimes it's just looking in the  electronic medical record along with the phone call, or providing emotional support, just being  available, which is invaluable. We know there'll be more pandemics and other global emergencies.  So let's take what we've learned, the good, the bad, and the ugly, and adopt or abandon or improve  so that some of it can become the norm. So we're very used to technology for when the next pandemic  emergency hits. We know what technology we need to use, and we can rapidly deploy that to the and we can rapidly deploy that technology without the angst and the anxiety that we've  all felt during this pandemic. So let's take the lessons learned and go forward  and keep learning and keep using the technology. Thank you for your time.

Video Summary

The COVID-19 pandemic accelerated the use of telecommunication platforms in healthcare. Organizations had to quickly onboard non-ICU clinicians to these platforms and address concerns such as HIPAA violations. The Office for Civil Rights at the Department of Health and Human Services allowed the use of non-public facing remote communication products without penalties during the pandemic. This led to an explosion in telehealth platforms and the adoption of tablets, online meetings, and new communication protocols. Factors influencing the adoption of technology included organizational, technological, and social drivers, as well as workflow integration, training, funding, and IT infrastructure. The pandemic also led to the expansion of ICU capacity outside traditional settings, with the use of video carts and tele-ICU technology in various locations. There were examples of successful tele-ICU deployments during the pandemic, demonstrating that sometimes advanced technology is not necessary and that existing resources can be used effectively. The use of virtual platforms for handovers, consults, and procedures also became common, allowing for immediate support and expert consultation. Tele-critical care teams also provided emotional support to patients and families. The pandemic has shown that healthcare can rapidly adapt to using technology, and the lessons learned should be used to improve preparedness for future emergencies.

Asset Subtitle

Professional Development and Education, 2022

Asset Caption

This session will focus on understanding the requirements and resources needed to expand tele-critical care services beyond the physical space of the ICU, using technology and skills used in the tele-critical care model. Speakers will discuss space, equipment, and personal and group skill sets required for such expansion, and provide insights into lessons learned from the pandemic to define the future.

Meta Tag

Content Type Presentation

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Telemedicine eICU

Tag Innovation

Year 2022

Keywords

telecommunication platforms

telehealth platforms

tele-ICU technology

virtual platforms

future emergencies

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