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Virtual ICU provides care across northeast Ontario

By Jerry Zeidenberg

SUDBURY, ONT. – Intensive care professionals are now able to provide their expertise to 16 hospitals across northeast Ontario through the Virtual Critical Care unit, an advanced telehealth system headquartered at Health Sciences North.

In January, the Virtual Critical Care (VCC) unit added seven smaller hospitals to the nine it was already reaching, enabling a team in Sudbury to offer around-the-clock support to remote critical care units and emergency departments that are often understaffed.

Joining the network are the emergency departments at Espanola Regional Hospital and Health Centre; Manitoulin Health Centre (Little Current and Mindemoya sites); Blind River District Health Centre; Chapleau Health Services; Mattawa Hospital; and Lady Dunn Health Centre in Wawa.

Using videoconferencing and access to electronic medical records, VCC team members can guide nurses and physicians at any of the 16 hospitals on the care needed by critically ill patients, including those suffering from trauma, severe infections, cardiovascular and lung failure, and other illnesses.

“In recent years, larger cities with academic hospitals have developed teams of intensivists, critical care nurses, respiratory therapists, pharmacists and dieticians,” said Dr. Derek Manchuk, lead physician of the VCC unit, critical care lead for the NELHIN and medical director of critical care for Health Sciences North. “Together, they have been shown to improve outcomes – such as mortality – and to reduce costs and length-of-stay.”

He asserted that smaller centres don’t have the benefit of these multi-faceted teams. The idea behind the Virtual Critical Care unit was to use high-powered videoconferencing to bring the knowledge and experience of an established intensive care team to remote hospitals.

“We’re able to give them equal access to care,” said Dr. Manchuk, adding that most remote hospitals have medical equipment, drugs and ventilators. “What they’re missing is all of the team members. And the smaller hospitals often don’t have the benefit of the experience that comes with high case volume.”

By videoconferencing with specialists at the Virtual Critical Care unit, rural physicians and nurses are often able to avoid transporting them to a larger, acute-care centre. Moreover, physicians in larger community hospitals obtain the benefit of second opinions on complex cases without transferring their patients.

That’s expected to improve outcomes for patients and reduce costs to the healthcare system, since transporting patients from rural areas can be hard on the patient and often requires an expensive air ambulance.

In the last year, the Virtual Critical Care unit has saved $450,000 in transportation costs by avoiding air ambulances and treating patients in their home communities.

Moreover, when it’s decided that moving a patient to Sudbury is the best course of action, the intensivists are able to start earlier on the appropriate medications and ventilation. In that way, patients arrive in better shape upon reaching the acute care centre.

Recently, a patient in the emergency department in Kirkland Lake suffered a heart attack. As the patient’s condition worsened, staff at the hospital contacted the Virtual Critical Care unit.

“We coached them through CPR and medications, and they did the resuscitation,” said Dr. Manchuk. “We also had them use a portable ultrasound, and we could see the images on our screen and comment.”

To create the Virtual Critical Care network, Health Sciences North partnered with the Ontario Telemedicine Network to create a high-powered system, including a new three-way videoconferencing interface.

This means the video system can support clinicians at the unit’s headquarters in Sudbury, doctors and nurses at any of the remote hospital sites in northeastern Ontario, as well as critical care physicians who might be away from the Sudbury nerve-centre but want to assist with the case.

In addition to the team in Sudbury, three critical care physicians in southern Ontario have been assisting the Virtual Critical Care unit, one from Kingston and two others from Oshawa.

When caring for a patient, the team also has access to the patient’s electronic health record and radiology images, which can be viewed on the system. It’s helpful that most hospitals in northern Ontario make use of a shared Meditech electronic patient record system.

For its part, the team in Sudbury has the help of 13 ICU physicians, along with nurses who have been given special training in both critical care and telehealth. Respiratory therapists, pharmacists and dieticians are also available.

The Virtual Critical Care unit has an operating budget of $1.2 million a year, and each of the 16 remote sites has been “gifted” with a videoconferencing station – a cart with a large monitor, computer, camera and software.

Dr. Manchuk observed that the project uses a ‘passive telemonitoring’ model rather than the active telemonitoring that’s sometimes found in the United States. With active telemonitoring, large centres staffed with physicians and nurses provide around-the-clock surveillance of remote critical care beds. They are able to view patients using cameras and have connections to their waveforms and vital sign instruments.

By contrast, with the passive telemonitoring used by the Virtual Critical Care unit in Sudbury, hospitals “call us when they need us,” said Dr. Manchuk.

The team can then start monitoring the patient using cameras and instruments, and some sessions have lasted up to three hours – until the patient has been stabilized or a decision has been made to transfer the patient to Sudbury. The team also provides follow-ups, checking on patients afterwards.

Dr. Manchuk pointed out that three studies have been performed in the United States to compare active and passive monitoring of ICU patients, and all have found outcomes in passive telemonitoring to be as good as the active variety.

As well, active telemonitoring is very expensive, and costs in the area of $125,000 per bed each year. Using this model, the 40 critical care beds alone being covered in northeastern Ontario would cost $4 million to $5 million each year to monitor. Additionally, the service is available to all of the emergency departments of the hospitals that are participating.

Dr. Manchuk believes his team can achieve equal results with the current model and budget of $1.2 million a year.

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