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Division of Pulmonary, Allergy and Critical Care Medicine

Since the beginning of the COVID-19 pandemic, every ICU bed in Alabama was full for weeks at a time — including those at UAB Hospital. Before the pandemic, the sickest patients would have been transferred to a major medical center like UAB, which is far more prepared to care for them than a more rural location, like Demopolis’ Whitfield Regional Hospital. However, it soon became apparent that even the 1,200-bed UAB hospital would quickly reach its capacity. Every ICU patient that hospitals like Whitfield could care for would be one less patient on UAB’s waiting list.
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While UAB couldn’t spare beds, it could share its expertise. From an operations center in Birmingham, UAB’s critical care pulmonologists can video into rooms in Demopolis, conducting remote exams of patients on ventilators in coordination with local hospitalists. The UAB tele-ICU operations center is part of a partnership between UAB and telehealth company Hicuity Health, which has 10 other operations centers that provide tele-critical care to more than 100 hospitals.

When a patient is admitted to Whitfield’s ICU, its hospitalists can call for a consultation with one of UAB’s tele-specialists, who usually pipes into the room via a rolling cart. As the Whitfield team conducts a physical exam, the remote doctor pivots the cart’s camera to see the patient and bedside monitors. After establishing the initial care plan, UAB’s doctors will call in every day to make rounds on certain patients, circling back to make recommendations and adjust settings on equipment.

“These are good hospitals, providing really good care,” said Steve Stigler, M.D., associate professor of medicine in the UAB Division of Pulmonary, Allergy, and Critical Care Medicine, medical director of the UAB Medical Intensive Care Unit, and leader of the UAB Tele-ICU operations center. “But if you need certain specialists, this expertise is not always available in some hospitals. That's a real limitation.”

In April 2021, Whitfield and UAB announced that the regional hospital would increase focus on tele-critical care: By early 2022, Whitfield will become Alabama’s first full external tele-ICU. Whitfield’s ICU will be outfitted with sensor-laden rooms that enable a team of remote nurses to monitor patients’ vital signs around the clock, managing their care and calling in hospitalists or remote critical care doctors when needed.

“With Tele-ICU and other UAB Telemedicine services such as nephrology, our team was able to care for many patients in Demopolis during the pandemic,” said Stigler. “I think for those patients who are especially critical and need different types of life-support, this is a good way to make sure we are continuously providing that high-quality care.”

Taking on this new treatment strategy was not a development either Whitfield or UAB expected, but this practice born from necessity suggests that even post-pandemic, tele-critical care could be an essential element to help develop rural hospitals and their patients.

Later this year, Whitfield will become the first ICU in the state outside of the UAB and UAB Highlands hospitals to have each room wired with cameras and monitored remotely by UAB nurses and doctors. This extra level of monitoring will support the care being provided by in-person clinicians.

“It made a lot of sense with Whitfield having moved to take care of patients who were a lot sicker than they were when we first started the tele-ICU,” said Stigler. “Whitfield also does its best to keep patients close to home, and that’s part of what made them the obvious partner for this program. Partnerships like this have been used elsewhere, and typically the impact is positive. We’re eager to see where it goes.”

Source: Katie Palmer, October 2021 https://www.statnews.com/2021/10/05/telemedicine-icu-covid19-hospitals/