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  • Creating a centralized ICU care system provides a mechanism for implementing 24-hour 7-day intensivist oversight of critically ill patients throughout a network of hospitals.
  • A major goal of centralizing ICU care is to spread intensivist care over larger numbers of patients, thereby extending both the number of patients managed by an intensivist and the hours of intensivist care. Creating a multidisciplinary remote care team in which ICU nurses and ancillary personnel work in support of the remote intensivist is central to maximizing operating efficiency.
  • Available data suggest that implementing a remote intensivist management program that supplements on-site physician care can improve clinical outcomes and economic performance. We speculate that dedicated off-site intensivists improve outcomes by closely monitoring patient status when there is no on-site intensivist, thereby ensuring that care plans are adhered to and that new problems are detected and addressed promptly.
  • The requisite technology includes 2-way audio and high-resolution video links to each patient room, a robust clinical information system that allows off-site physicians to access patient data, technology tools for performing routine care tasks (e.g., creating notes and orders), and a robust and secure broadband wide area network.
  • Clear definition of roles and responsibilities, detailed elucidation of operating procedures, including how the remote program integrates with on-site physician activities, and ensuring compliance with standard inpatient care policies (e.g., licensure, credentialing, quality assurance, and the Health Insurance Portability and Accountability Act) are essential for a smoothly functioning and effective program.
  • Centralized ICU care programs as part of a system-wide view of ICU care ensuring consistent 24-hour 7-day intensivist oversight and the use of an information technology backbone, create unique opportunities to standardize care practices, enhance operating effectiveness, and improve outcomes.

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There is wide variation in intensive care unit (ICU) care across U.S. hospitals. Despite data showing improved clinical outcomes with dedicated intensivist staffing1 and the institution of a variety of best practices,2 few ICUs are able to implement these care practices broadly and consistently. Fundamental problems in our current health care system make the goal of optimal ICU care nearly unobtainable for most hospitals. Considerable attention has been devoted to the current shortage of intensivists3 and the high cost of 24-hour 7-day staffing models. Similar focus has been devoted to the difficulty of getting physicians to adopt best practices. While there are behavioral and managerial components to this problem, the lack of real-time prompts and data-based feedback represent equally important obstacles. Even where hospital leadership appreciates the clinical and financial impact of improved ICU care, the path is both costly and difficult. This chapter presents an alternate care paradigm—one that addresses many of the most serious barriers to improving ICU care. There are three core concepts central to this new care model. First, ICU care is viewed as a system-wide problem, where care across multiple institutions is addressed comprehensively, resources are shared across a network of facilities, and care practices are systematically standardized. Second, technology tools and alternate staffing patterns ...

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