Clinicians must remain ever vigilant in a busy intensive care unit, where a short delay can turn a preventable problem into rapid patient deterioration.

But this is increasingly difficult as an older patient population demands more complex care and a lack of intensivists hinders ICU patient outcomes.^1,2

"We're facing a serious shortage," said James A. L. Mathers Jr., MD, FCCP, president of the American College of Chest Physicians. "We're going to have to look at technology to help solve that problem." Telemedicine, a still evolving subspecialty, has caught the eye of Dr. Mathers, who also is a partner with Pulmonary Associates of Richmond, Va. He has seen a telemedicine control center monitor as many as 60 beds over seven ICUs in five different hospitals around the clock.

"You instantly are aware of any evolving problems, particularly cardiac arrhythmias, falling oxygen saturations, and electrolyte abnormalities," Dr. Mathers said. "That all is being picked up in real time." Telemedicine's potential extends beyond the critical care setting to reach rural populations, according to a study by the Veterans Affairs Medical Center in Milwaukee.³ Pulmonary physicians provided outpatient consultations with the use of videoconference technology to successfully manage 314 underserved patients in a remote clinic. Telemedicine saved patients 294,120 miles of travel over the seven-year study period.

Even President Barack Obama has taken notice of telemedicine's potential, promising to widen the nation's use of telemedicine "to bring important health care services to isolated rural communities" and to "strengthen the VA's telemedicine infrastructure to expand the delivery of high quality health care to veterans residing in rural communities."4 Home care monitoring is another opportunity for telemedicine to help respiratory patients. Manufacturers on top of this trend are producing wireless or computerized spirometers, oximeters, or remote patient monitoring devices that could help clinicians anticipate exacerbations of diseases such as asthma and chronic obstructive pulmonary disease and prevent emergency room visits.

"The challenges right now are combining known science with the available technology," Dr. Mathers said. "That is just going to require further research to determine which specific subgroups will benefit and which specific parameters will be indicative of the problem." The ACCP currently is lobbying for passage and implementation of SB 718/HR 3886 to appropriate five million dollars for the Agency for Healthcare Research and Quality to study the use of telemedicine in ICU care and 30 million dollars over five years for Department of Health and Human Services to study standardization of ICU care across the country.

References

1. Kelley MA, Angus D, Chalfin DB, Crandall ED, Ingbar D, Johanson W, et al.The critical care crisis in the United States. Chest. 2004;125:1514-7.
2. Health Resources and Services Administration Report to Congress: The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians. May 2006.
3. Raza T, Joshi M, Schapira RM, Agha Z. Pulmonary telemedicine < a model to access the subspecialist services in underserved rural areas. Int J Med Inform. 2009;78(1):53-9.
4. Real Leadership for Rural America. Chicago: Obama for America. Barack Obama's Rural Plan. Available from: http://my.barackobama.com/page/content/ruralplan

Kristen Ziegler is assistant editor of ADVANCE. She can be reached at kziegler@advanceweb.com.

Physicians Roundtable is a joint venture of ADVANCE and the American College of Chest Physicians. For more information on ACCP activities and offerings, contact David Eubanks, EdD, RRT, FCCP(Hon), at (847) 498-1400. For membership information, call Tracy Goode at the same number, or write to ACCP, 3300 Dundee Road, Northbrook, IL 60062-2348. You can also reach the ACCP online at www.chestnet.org or by e-mail, accp@chestnet.org.