ROBOTIC TELEMETRY FOR RURAL ICU AND ER SERVICES
Intensive care is one of the hospital's most complex and expensive medical systems. More than 4 million patients are admitted to ICUs each year in the US. Approximately 500,000 patients die in ICUs each year . Mortality rates in patients admitted to the ICU average 10% - 20% in most hospitals1. It is estimated that while patients in ICUs occupy between 5% - 10% of inpatient beds in hospitals throughout the US, the expense associated with these beds is 20% - 35% of total hospital costs1. Further, an average ICU patient experiences 1.7 errors/day and 1 in 5 patients may sustain a serious adverse event during their hospitalization in a critical care unit1.

Attention has now shifted to improving patient safety, delivery of quality care, reducing medical errors and reducing health care costs – these issues typically get top billing among most hospital boards. They are also issues that have many hospitals reassessing how they deliver care among their sickest patients – those in ICU.

The LeapFrog Group has called for full-time intensivist staffing as a way to save as many as 50,000 lives per year. However, it is estimated that there are fewer than 6000 actively practicing intensivists in the US today and only 13% of ICU patients receive dedicated intensivist care. The demand for critical care and ICU services is projected to rise substantially over the next few decades as the American population ages2 . Four times as many full-time intensivists are currently needed to provide around- the-clock staffing for the more than 7000 ICUs nationwide. Not all hospitals are succeeding at recruiting intensivists. A shortage of these specialists presents a major obstacle to the adoption of ICU intensivist staffing, especially in smaller facilities.

Critical Care Challenge

Meeting the needs of critically ill patients in small and medium size rural and community hospitals is a big challenge. Smaller hospitals often:

  • Lack economic resources of urban medical centers that can afford multiple specialty consultants and procedures
  • Have a shortage of nurses and medical specialists including intensivists
  • Have a difficult time retaining and training staff
  • Do not have capital to install and upgrade expensive bedside monitoring systems


OFFSITECARE CLINICAL MODEL

OffSiteCare Inc. – Anywhere, anytime care & Dr. James Gude3

OffSiteCare uses InTouch Health’s Remote Presence Robotic System to provide intensivist coverage to rural and small ICU’s3.

OffSiteCare Inc. was founded by Dr. Lewis Solomon and Dr. James Gude in 2006. Dr. James Gude is OffSiteCare Medical Director and Board Certified in Pulmonary, Critical Care and Internal Medicine3. He received his Medical Degree from Yale University in 1965. He has practiced Pulmonology and Critical Care Medicine in California for 35 years. He is a Clinical Professor of Medicine at The University of California San Francisco. As part of OffSiteCare critical care network associations, he is also currently the Medical Director of both Palm Drive and Healdsburg District Hospital ICU's.

OffSiteCare currently contracts with 3 rural northern California hospitals to offer two different service delivery models based on Remote Presence care. It has installed InTouch Health’s robots in the ICU's of these 3 hospitals.

Services Offered

OffSiteCare offers two levels of service to hospital customers. The highest service level is a blended model of On-site and Remote Presence physician coverage to create 24/7 intensivist coverage. In this model a board certified intensivist is physically present in the hospital about 8 hours per day, 5 days a week. A lower level of service is delivered exclusively via Remote Presence, however, OffSiteCare still includes the same service activities and 24/7 availability as in the higher service package. Those specific services include:
  • ICU Team rounds twice daily (AM & PM)
  • Rapid response
  • Red alert investigation
  • Preventative measure checks for – DVT, peptic ulcer among others
  • ICU nurse consults
  • Continuity of care physician follow-up on patients discharged to wards
  • Implementation of 25 evidence based best critical care practices which drive adoption of the latest intervention treatment protocols


OffSiteCare Network Expansion3

In the near-term, OffSiteCare is planning to expand their services to 3 other Northern California hospitals. Discussions are also under way to provide Remote Presence Robots to several Northern California clinic settings.

OFFSITECARE BUSINESS MODEL

The annualized hospital costs of OffsiteCare services run between $250K and $500K less billable physician services turned over to the hospital if an intensivist is onsite. A summary of the OffsiteCare charges is shown below. NOTE: The following numbers may be subject to change.

  • Startup costs $20,000
  • Unit management fee $5,000/month
  • Remote presence system $6,500/month

Service packages
  • Onsite 40hrs + 24/7 call $1,000/day for Intensivist Services
  • Remote only + 24/7 call $ 300/day if ICU = or <4 beds; $500 if >4
  • Remote only without call Consultation As Available with Charges
  • Intensivists and Consultants have EMMI bill for services with 20% for overhead and 80% to the Consultants
  • Hospital can bill for allowable physician services with Onsite 40hrs + 24/7 call


OFFSITECARE CUSTOMER RESULTS

The implementation of OffSiteCare Outreach Model in ICUs of 3 northern CA rural hospitals has brought about some dramatic results. These are discussed for the individual hospitals below:

Palm Drive Hospital5,6 – Since its ICU reopening in July 2007

  • The ICU has been full and has contributed to bringing hospital out of Chapter 9 bankruptcy.
  • This hospital saw doubling in patient census from 7 to 15-20.
  • There has been a 40% increase in revenues – the ICU service has been credited as a major contributor to hospital’s financial turnaround.
  • There are more surgeries taking place in the Operating Room & more patients are being directed to diagnostic and imaging services.
  • More patients are remaining at Palm Drive (includes more ER transfers to ICU) instead of transportation to other hospitals in Santa Rosa after being stabilized.
  • Improved contracts with health insurers & hospitals are in place.


Howard Memorial Hospital9 – Since the ICU opening

  • There has been a dramatic increase in patient census (due to the Orthopedic Surgeon taking larger volume of cases and more complex cases which account for nearly fourth of all patients admitted).
  • There has also been an associated significant financial turn around.


Healdsburg District Hospital7,8 This hospital reopened its ICU in January 2008.


1. “Improving Care in the ICU”, A Joint Commission Resources Mission publication, pg. 3, 2004.
2. Angus DC, Kelley MA, Schmitz RJ, et al: Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA 2000; 284:2762–2770
3. offsitecare.com
4. scma.org
5. The Press Democrat
6. The Press Democrat
7. The NB Business Journal
8. The Press Democrat
9. The Pacific Union Recorder