Changing models of care in ICM? #LIVES2017

I am still not sure what the question is (?!), but this poll at the start of this session looked like tele-ICU didn’t answer it….

The first speaker was Charlie Corke from Australia, who talked about what it meant to him – “Failure to rescue in the wards: human factors and technology”.  He talked through the 2004 ACADEMIA study – this was a collaboration and comparison between the Intensive Care Society and Australia’s ANZICS group that showed “bad things happen before Intensive Care admission”.  The following year the (in)famous study of rapid response MET teams (the MERIT study) was published, which failed to find any effect on cardiac arrest, unplanned ICU admission or unexpected death from the activation of these teams.

He then seemed to be making a call to arms for remote monitoring, but didn’t seem to know of many of the recent advances is the field!  The audience helped him out – there are a lot of remote monitoring and tele-medicine advances in monitoring respiratory rate, but none quite at full clinical roll out stage yet… (for example http://www.oxehealth.com/ or even http://www.acupebble.com/)

Then Richard Beale took to the stage – High cost or cost saving? was the topic.  He recommended this JAMA paper.  It defines the tele-intensive care unit nicely as:

A tele-intensive care unit (ICU) is a promising technological approach designed to systematically alter processes of care that affect outcomes. Tele-ICU can be defined as the provision of care to critically ill patients by health care professionals located remotely. Tele-ICU clinicians use audio, video, and electronic links to assist bedside caregivers in monitoring patients, to oversee best practice adherence, and to help create and execute care plans. Tele-ICU programs have the potential to target processes that are associated with better outcomes, including shorter response times to alarms4 and abnormal laboratory values,5 more rapid initiation of life-saving therapies,6,7 and higher rates of adherence to critical care best practices.8

These systems seem to save money… So they are probably coming to a (large?!) unit near you soon.

Then my favourite talk of the session was from Marius Terblanche (follow him on twitter) who had spent a lot of his early consultant life implementing a tele-medicine system in Guys and St Thomas’s hospital in London.  He gave a refreshingly honest account of this, and recounted the problems he faced as he went along.

He ran through all the lessons he had learned, including simple things like the need to consider the “estate” – he found that background noise was a problem for cameras and microphones.  But the biggest problem the implementation faced was convincing people to change -disruption to job plans, ways of working etc.! Trying to create and convey a “sense of urgency” and need was tricky, he found that without an influential “guiding coalition” it was hard to move forward (not necessarily just powerful – an interesting distinction).  He admitted that without a clear vision to communicate, it is hard to convince people to undergo such big change and that he felt that he could have done that better.  He also thought that it was/would have been important to create short term wins with such a project, and also not to announce success too early.

Are you trying to do something similar and want to know more?  Well his recommended reading was not about tele-medicine or technology, but change management – and John Kotters 8 steps.

Overall an inspiring talk and a great debate at the end with audience pitching in.  Prof Bion raised the major challenge with tele-ICU – and our challenge to avoid as these systems become more widespread: