For nearly a decade, Orlando Health has been a pacesetter in tele-ICU care. The central Florida health system has nearly 2,300 beds across six acute care hospitals. Dr. Jeffrey Sadowsky wears two hats at Orlando Health: corporate director for critical care and medical director for telehealth. Here are some of his thoughts on the rapidly evolving tele-ICU field.
AS TOLD TO KRISTI LABRUM
On Rapid Response
“In the intensive care unit, things change every second. If someone has cardiac arrest, I can beam in quicker [with telehealth technology] than someone in the hospital who’s running to the code. I can also see patients at different facilities within 30 seconds.”
On Tele-ICU Workflow
“A typical work flow for me would be to beam in, drive the telehealth device to the charge nurse, grab the respiratory therapist and then start doing multidisciplinary rounds. We drive to the patient’s bedside and the bedside nurse will give a report. I can take a close look at the patient and ventilator – and even see what setting the drips are on. Then we come up with our goals for the night. If it’s a new patient, I’d do a whole physical examination. I usually start with zooming in on the pupil. With the InTouch telehealth device, I can also listen to heart and lung sounds.”
On Tele-ICU Care Coordination
“By being at the bedside quickly and continuously if need be, we can get people off the ventilator quicker and get them out of the ICU more rapidly. Therefore our length of stay is decreased. Our cases of ventilator-associated pneumonia have decreased – and our mortality rate has improved. Our throughput time through the ICU has also improved. With telehealth, we’re opening up ICU beds for new patients.”
On Tele-ICU Quality
“The improvement in our quality issues and length of stay is because we have a small group of physicians that are working with standardized care. The daytime physician and nighttime physician do things the same way. We’re also available 24/7. We’re not a consultative service where someone beams in, gives recommendations and leaves. We’re actually the physicians of record. Even when I’m there virtually, they’re still my patients. I’m managing them.”
On Family Rounding
“My next step is to bring virtual health to family rounds. On our day shift, we usually do family rounds between 3:00 p.m. and 4:00 p.m. We talk to the patient and family members at the same time. But some families can’t be there. We have a lot of destination patients, and their families can’t be there. With telehealth, you can bring the family to the bedside.”
On Tele-ICU Productivity.
"With telehealth, one of the exciting things is that I can be at three different facilities at pretty much the same time. I can be at one facility on my iPad, another facility on my iPhone and another facility on my desktop. And I can take care of three patients simultaneously. That’s exciting.”