{"id":14691,"date":"2016-11-15T18:40:03","date_gmt":"2016-11-15T23:40:03","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-rctom\/submission\/from-iditarod-to-the-icu-transforming-critical-care-in-alaska\/"},"modified":"2016-11-15T18:40:03","modified_gmt":"2016-11-15T23:40:03","slug":"from-iditarod-to-the-icu-transforming-critical-care-in-alaska","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-rctom\/submission\/from-iditarod-to-the-icu-transforming-critical-care-in-alaska\/","title":{"rendered":"From Iditarod to the ICU: Transforming Critical Care in Alaska"},"content":{"rendered":"

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The iconic Iditarod Trail Sled Dog Race was inspired by the 1925 mission to deliver lifesaving diphtheria medication via dogsled to the remote village of Nome, AK\u00a0[1]<\/a>. 90 years later, Alaska still grapples with providing quality, cost-effective care to patients in America\u2019s most geographically dispersed population\u00a0[2]<\/a>. Alaska has 14% fewer physicians per capita than the national average\u00a0[3]<\/a>, and the lack of qualified clinicians often forces critically ill patients in rural areas to be flown to Seattle or Anchorage for care at significant cost\u00a0[4]<\/a>. Exacerbating Alaska\u2019s physician shortage is its notoriously challenging weather, which routinely makes medevac flights unsafe.<\/p>\n

In 2009, Providence Alaska Medical Center responded to this challenge by introducing eICU, a two-way video and data streaming platform, to care for critically ill patients statewide from its Anchorage monitoring center.\u00a0 eICU critical care physicians (known as intensivists) and nurses remotely monitor patients\u2019 vital signs, laboratory results, and medications in real time, communicating their recommendations to bedside providers.\u00a0 eICU has already lowered costs and improved quality at Providence\u2019s own physical ICU in Anchorage, as well as at several other Alaska hospitals.<\/p>\n

Is this an Alaska-only project, or could Providence continue to monetize its expertise at rural hospitals nationwide?<\/p>\n

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Dr. Javid Kamali, an intensivist (critical care physician), helps care for\u00a0patients across the state from Providence Alaska Medical Center\u2019s eICU monitoring center in Anchorage (source: Providence Health & Services Alaska).<\/em><\/p>\n

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Improving Providence\u2019s Internal ICU Operations<\/h1>\n

Before launching eICU for remotely-located hospitals, Providence piloted the system at its own 28-bed intensive care unit in Anchorage.\u00a0 eICU helped Providence achieve:<\/p>\n

Improved Nurse Retention<\/h2>\n

Even in urban Anchorage, few physicians are available in the hospital at night.\u00a0 Before eICU was implemented, if nurses became concerned about patients after hours, they had to phone doctors for counsel.\u00a0 Nurses were reluctant to disturb doctors, who resented the need to make sometimes unnecessary after-hours trips to the hospital to assess questionable patients.<\/p>\n

Today, nurses simply contact the after-hours eICU physician on duty, who visualizes patients using high-definition video and orders appropriate therapies.\u00a0 Having 24\/7 access to physicians has improved nurse satisfaction and retention\u2014a welcome outcome for an organization that expends $20,000-$60,000 to replace each nurse\u00a0[5]<\/a>.<\/p>\n

Improved Care Quality<\/h2>\n

In addition to audio\/visual capabilities, eICU algorithms monitor patients\u2019 physiologic parameters, including blood pressure, fluid input\/output, and lab values.\u00a0 \u201cSmart alerts\u201d trigger eICU staff to notify bedside clinicians to intervene as soon as abnormalities arise.\u00a0 Furthermore, eICU clinicians can double-check hospitals\u2019 compliance with best practices.\u00a0 For example, eICU staff helped Providence improve its frequency of compliance with protocols for ventilator-managed patients from 86% to 98%.\u00a0 Additionally, since eICU\u2019s implementation, Providence has reduced its risk-adjusted ICU mortality rate to 52% below the national rate [6]<\/a>.<\/p>\n

Deploying eICU Throughout Alaska<\/h1>\n

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An emergency department clinician at South Peninsula Hospital in Homer, AK, demonstrates the mobile cart that connects his patients with the eICU team in Anchorage (Source: Peninsula Clarion).<\/em><\/p>\n

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Today, Providence provides eICU services to medical centers in Kodiak Island, Juneau, and Homer, AK, none of which have on-site intensivists.\u00a0 These hospitals benefit from the same improvements in nursing retention, care standardization, and patient outcomes that Providence realized at its own ICU.\u00a0 In addition, member hospitals have reduced their patient transfer rates.\u00a0 For example, during Kodiak\u2019s first year in the program, eICU access enabled the hospital to avoid transferring 17 patients, at an average cost of $20,000 per transport [8]<\/a>. The Kodiak hospital pays Providence $40,000 per year in eICU service fees.\u00a0 It recoups its investment many times over in reduced transfer costs, as well as higher patient care revenues since these patients receive all of their care in Kodiak.<\/p>\n

Next Steps<\/h1>\n

As Providence looks to enhance and expand its eICU business, it should focus on three imperatives:<\/p>\n