Rationale / Objectives
Dignity Health Woodland Memorial Hospital, a 108-bed community medical center in California, originally had one intensivist to cover eight beds in the ICU. It was estimated that it would cost $300-$500K per year to hire an additional intensivist, so it launched a teleICU component to provide constant coverage. TeleICU has demonstrated favourable outcomes in a recent systematic literature review.
Project/Program Description & Major Achievements
The Dignity Health Telemedicine Network provides support to Woodland Healthcare physicians via high-speed data lines and the use of an autonomous robotic navigation system (RP-VITA™) to quickly evaluate, diagnose and treat patients in the intensive care unit (ICU). One year after the go-live date, the hospital's patient satisfaction scores are 91%; there has been a 60% reduction in mortality rates; a 60% reduction in re-intubation; a 40% reduction in emergency department transfers and a 10% percent drop in intensive care unit transfers. Additionally, the hospital doubled the contribution margin per patient with its investment in teleICU technology.
Challenges to telehealth include physician credentialing, differing state licensing regulations, as well as upfront operational costs and low reimbursement for the services. Reviewing guidlines for telehealth ICU operation are important for other organizations seeking to implement this technology.
Dignity Health Woodland Memorial Hospital is located in Woodland (near Sacramento) California and has 108 licensed acute-care beds (including a 17-bed Emergency Department and 8 bed medical/surgical intensive care unit) as well as an additional 31 Inpatient Mental Health beds. The Dignity Health Telemedicine Network provides high-speed data lines and InTouch Health wireless remote robots to support physicians to quickly evaluate, diagnose and treat patients in the intensive care unit (ICU). Patients are connected to intensivists from control stations located at Mercy General Hospital in Sacramento, and Mercy San Juan Medical Center in Carmichael. The care team includes physical therapy, respiratory therapy, pharmacy, nursing, hospitalists, and on-site intensivists. If there is a sudden change in a patient's condition and there is an immediate need for an intensivist, the robot (called the RP-VITA™ which was developed in partnership with InTouch Health and iRobot) is activated and the team can consult and make care recommendations with intensivist input. The 5 foot 6 inch tall robot has a flat-screen monitor where patients and families can see and interact with the physician in real time. The robot (used in over 100 U.S. hospitals) has a zoom-lens camera and microphone to allow the physician to see and hear patients during examinations, in addition to viewing charts, test results and diagnostic images.
One year following implementation, the hospital's patient satisfaction scores are 91%; there has been a 60% reduction in mortality rates; a 60% reduction in re-intubation; a 40% reduction in emergency department transfers and a 10% percent drop in intensive care unit transfers. Additionally, the hospital doubled the contribution margin per patient with its investment in teleICU technology. The traditional intensivist staffing cost the hospital $100,000 per monitored bed per year compared with $30,000 per monitored bed per year for the teleICU model. A telehealth component for cardiology and psychiatry will be added in the near future.
|Patient Satisfaction||91%||one year folllowing implementation|
|Mortality Rates||60% reduction|
|Re-intubation Rates||60% reduction|
|ED Transfers||40% reduction|
|ICU Transfers||10% reduction|