Perspectives on the Electronic ICU

Abstract

Electronic ICUs (eICUs) have arisen as an effort to improve the intensive care medical coverage still unavailable to many patients. The overriding issue is the ongoing shortage of critical care medicine physicians and an ever-growing population of critical care patients. However, it has been difficult to conclusively define the outcome benefits in terms of mortality or ICU length of stay following establishment of an eICU program. Successful outcomes have been demonstrated in ICU settings ranging from academic to rural, but eICUs may have the most impact in ICUs that ( a) begin with a deficit ofintensivist coverage, ( b) have high severity-adjusted mortality and long length of stay rates, ( c) are located remotely where safe transfer of high acuity patients is not possible, and ( d) are part of an organizational structure that support the tele-ICU intensivist’s management of the patient. Acceptance of telepresence technology and particularly the acceptance of a remote intensivist managing patients can encounter strong resistance by many bedside clinicians. Third-party payers have traditionally not paid for intensivists to provide patient care via real-time telemedicine systems. There may also be vulnerability to liability to all those involved in ICU care if communication between bedside and eICU practitioners break down. This review describes the various components of an eICU program and discuss the barriers we encountered in developing an eICU program in a large, multihospital health care system.