Telehealth and telemedicine, including teleICU/tele-critical care, are a vital part of the response we are seeing to battle COVID-19. I attended an informational meeting from the American Telemedicine Association (ATA) about the teleICU response and want to share some of the great ideas I heard.
I know a hospital that is their teleICU services to help monitor the donning and doffing of personal protective equipment (PPE) for nurses caring for patients with COVID-19. Nurses have requested this service because monitoring creates security and confidence, to ensure they are donning and doffing PPE correctly to avoid any breaches. The other benefit is that the teleICU practitioners can identify if there has been a breach, notify the nurse quickly so the nurse can be isolated and reduce the risk of spreading the virus.
Hospitals are also using their teleICU services to monitor patients, reducing the number of times a nurse or another provider needs to enter/exit the isolation room and minimizing potential exposure. Some of their tasks include monitoring and charting vital signs and urine output. TeleICU monitoring is also extremely helpful to assist the nurse in an isolation room. TeleICU practitioners can communicate with the nurse in the isolation room. If the nurse needs more supplies or assistance, the teleICU can call the unit to request the help or the supplies, eliminating the need for the nurse to step out of the room to ask for those items.
In hospitals where teleICU isn’t hardwired, these facilities deploy telemedicine carts to provide support. Some hospitals have created units to cohort COVID-19 patients and use tablets on a secure network in each room for the patient to communicate with staff. This procedure reduces the number of times a staff member has to enter the room. One of the concerns raised by staff regarding the telemedicine carts was how to clean them after use in an isolation room. The recommendation is to follow your hospital’s protocols for cleaning equipment for patients in isolation for droplet precautions.
The Federal Communications Commission (FCC) has allocated money to support health systems with telehealth services, and if approved it will help eligible healthcare systems purchase equipment necessary to provide telehealth services.
Hospitals are already near capacity treating the flu and other conditions. Telemedicine is also being used to help identify which patients can be triaged out of the hospital to make room for a surge in patients with COVID-19. A recent webinar by the ATA described the management of patients with COVID-19 and how the use of telemedicine is helping. See the ATA’s webinar series for using telehealth to manage patients with COVID-19.
Another area where telemedicine can help is in following the CDC recommendation to screen patients before they enter the healthcare facility. Telemedicine is used to screen patients prior to them entering the hospital to prevent exposure of bedside clinicians. For example, if I have symptoms I am concerned about, I can use my electronic health record (EHR) patient portal to contact my provider. Facilities with telemedicine capabilities can use their EHR portals to schedule outpatient visits. Baptist Health South Florida has enabled a direct to the consumer platform app called Care On Demand. They have made it available nationwide to provide a place to treat patients virtually.
For questions on how nurses use teleICU, see “AACN Tele-critical Care Nursing Practice: An Expert Consensus Statement Supporting Acute, Progressive and Critical Care 2022.”
As healthcare providers, you are at the forefront of this crisis and are creating and innovating solutions to manage these patients. Share your ideas with the community so we can continue to learn from each other.
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