The University of Pennsylvania Health System (UPHS) and Good Shepherd Penn Partners (GSPP) of Philadelphia, PA, jointly earned recognition as a finalist for ECRI Institute's 5th Health Devices Achievement Award for establishing a telemedicine intensive care unit in GSPP's long-term acute care facility, providing bedside clinicians at GSPP with immediate access to expert critical care practitioners from UPHS.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and four other finalists for the 5th award in October 2010. Learn about the other submissions that achieved recognition. 

The Concept

The University of Pennsylvania Health System (UPHS) and Good Shepherd Penn Partners (GSPP) have aligned to provide a telemedicine intensive care unit in GSPP's long-term acute care facility. The use of telemedicine technology provides the bedside clinicians at GSPP with immediate access to expert critical care practitioners from UPHS.

The telemedicine setup facilitates communication between care providers at the two locations, allowing the remote intensive care unit (ICU) team, for example, to consult on critical issues and monitor patients for physiologic deterioration. As such, telemedicine has the potential to improve patient outcomes. In addition, these consultations can lead to treatment decisions that reduce the number of transports from the long-term acute care (LTAC) facility to a facility with a higher level of care. This can have significant cost implications, since the reimbursements that the LTAC facility receives for Medicare patients are linked to the average length of stay. To receive reimbursement for long-term care, the facility is required to manage Medicare patients, in aggregate, for an average of 25 days.

The telemedicine ICU program has physicians and other clinicians who provide coverage from 7 p.m. to 7 a.m. These clinicians remotely track compliance with evidence-based practices, including those for stress ulcers, low-tidal-volume ventilation, deep vein thrombosis prophylaxis, transfusion parameters, glycemic control, beta-blocker usage, and the ventilator and sepsis bundles. With this setup, the interaction flows in two directions: Intensivists and critical care nurses in the remote center recommend interventions to the bedside clinicians, and the bedside clinicians in the LTAC facility consult with the remote team to discuss complex issues. The clinicians at the two locations work in tandem to identify trends in the patient's status.

From July 2008 to July 2009, 92 interventions from the program were documented. Each was reviewed to determine whether it prevented an "acute out" (transporting a patient to a higher level of care due to an acute condition). Of the 92 interventions, 38 were determined to have prevented such a transport. Those 38 interventions occurred on 26 patients, 21 of whom had been in the LTAC facility for fewer than 25 days at the time of the intervention. Another sign of success was that the LTAC facility met or exceeded national benchmarks in preventing nosocomial infection rates.

From the LTAC facility's perspective, the telemedicine ICU program accomplishes the goal of eliminating preventable early transports from the facility, thereby ensuring ongoing reimbursement, in a manner that is less expensive than having on-site intensivists. 

Best Practices for Other Facilities

The telemedicine model described here is not just relevant in the LTAC world: The need for intensivists' expertise is outstripping the number of intensivists, and there are no indications that this trend will reverse. In addition, this application shows how, through creative partnering, it is possible to leverage the strengths of one facility to solve a problem for another. We were also impressed by the innovative way these partners took a system that is normally used for one purpose—helping rural hospitals deal with their more serious patients—and found another use for it that is mutually beneficial to both partners.