Using telehealth to improve night-time ICU care

Intensive Care Units treat the most sick people in a hospital and requires round-the-clock staffing by doctors and nurses. 24-hour staffing, however, means shift working and an inevitable night shift. To make it fair on all staff the shifts are usually rotated so any doctor or nurse would do a period on one shift and then move to the next shift.

It is not surprising that the more senior staff manage to have less night work than newer, less experienced ones. On the other hand night shifts may have attractions such as extra pay and this may be more important to the lower paid less experienced staff than to the higher paid senior ones. Also, the cost of staffing nights with less experienced staff may prove cheaper for the hospital. Nevertheless, the patients’ needs are no less important at night than during the day. Another aspect of night-time care is the possibility that a doctor or nurse may not be as alert at night as they would be in the day-time.

Looking at these downsides of night-time ICU care staffing, an hospital in the US has come up with a novel idea – move the doctors and nurses to a zone where it is day-time when it is night-time at the hospital and use telehealth to connect them. This is counter intuitive and has its own drawbacks.

Georgia’s largest healthcare provider Emory Healthcare is sending some ICU doctors and nurses to Sydney, Australia, for tours of six to nine weeks at a time, in a trial to staff ICU at night with health staff in a daylight zone using telehealth. The six month trial in collaboration with Philips and Australia’s Maquarie Health has been underway for 3 months.

The reason this is counter-intuitive is that telehealth was invented to overcome the problems associated with healthcare professionals and patients not being at the same location and here the two are being artificially removed to two ends of the world. While telehealth is a good solution to the diagnosis and treatment from afar, most professionals are likey to agree that it is inferior to being face to face with the patient. So it will be good to see the conclusions reached by this trial on how any drawbacks of distance balances out with having more alert doctors and nurses.

See also mHealth Intelligence article here.

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