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Beyond the Bunker

A Decentralized Model for Tele-Critical Care

For the entire history of critical care telemedicine, the practice of tele-ICU has been primarily associated with central command centers. Central command centers, also referred to as bunkers or hubs, link intensivists and other personnel to multiple hospitals so that a relatively small number of critical care physicians can oversee the care of a large number of ICU patients.

Capital costs of construction, installation, and training for a new command center range from $6 million to $8 million. At a time when healthcare costs must be minimized, reconsidering the value of central command centers is necessary.

In numerous studies, tele-ICU has shown to improve patient outcomes and decrease mortality as well as ICU length of stay. Tele-ICU has clearly shown value in keeping patients closer to home, allowing smaller hospitals to treat high-acuity situations. So the question is, how key is a central command center to an effective tele-ICU program and can a decentralized model be as effective.

A command center is staffed by many nurses who are deeply engaged in data collection for analytics and quality audits. With the advent of AI and machine learning, many of these tasks could be automated and the expertise of these personnel could be devoted elsewhere within the highly constrained healthcare system.

The key resource in the command center is the intensivist. On a basic level, we must consider if there are less expensive models to deliver intensivist services to remote settings. Simply stated, thousands of hospitals cannot afford to subscribe to the bunker-style tele-ICU with its heavy infrastructure. What they are looking for is a cost-effective and efficient means of access to ICU specialists.

With provider burnout at an all-time high and a shortage of intensivists, to not exacerbate the shortage we must also consider what conditions will be attractive to intensivists. Critical care physicians sit in these central command centers for shifts that are typically 12-hours long, scanning dozens of computer screens. This arrangement does not present a very attractive lifestyle option to intensivists, especially when many have additional specialties such as pulmonology that provide the option to work in an outpatient setting. If an intensivist can provide quality care to a remote hospital from the comfort of his or her own home as opposed to sitting in a bunker, he or she will likely see that as more attractive and devote more time to intensive care. Omnicure supports better quality of life.

Omnicure presents an option for critical care that does not require a central command center. With modern wi-fi and the emergence of 5G, internet connection from home is more robust than ever. The expensive infrastructure of central command centers for dedicated internet and T1 lines is a remnant of the past. This infrastructure was necessary when tele-ICU began in the year 2000, but as technology evolves, our delivery of care must also be upgraded and updated in a cost-effective manner.

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