Rohit R. Gupta, MD, center, with Critical Care fellows Alfred R. Schwab, MD, left, and Adewale Olayode, MD, consults remotely with Steven S. Chao, MD, Director of Critical Care at Mount Sinai Queens.
Intensive care unit (ICU) physicians at The Mount Sinai Hospital and Mount Sinai Queens are consulting remotely on complex cases with Tele-ICU, a service developed by the Mount Sinai Health System’s Institute for Critical Care Medicine and Clinical Innovation team.
Tele-ICU makes use of audio-visual technology and Epic Canto, a secure app that provides extensive, real-time electronic medical information. “This technology-enabled care allows the Mount Sinai Health System to provide specialized consult services to our ICU patients at Mount Sinai Queens and keep many patients in their own community and close to their loved ones, while supporting Mount Sinai Queens’ goal of treating patients with increasingly complex medical needs,” says Roopa Kohli-Seth, MD, Director, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai.
The Mount Sinai Hospital has more than 7,000 intensive care admissions a year in units for cardiac, cardiovascular, cardiothoracic, medical, neurosciences, surgical, and transplant care. They are staffed 24 hours a day with intensivists, board certified specialists in critical care. Mount Sinai Queens has an eight-bed intensive care unit, led by intensivists and ICU hospitalists.
When cases are particularly complex, Tele-ICU allows physicians at Mount Sinai Queens to compare notes with intensivists at The Mount Sinai Hospital. ICU physicians at both sites are equipped with monitors that show information from Epic, such as lab-test results and medical history. The physicians converse on tablets—similar to FaceTime but secure and encrypted—which can be turned toward patients to help visually assess their condition. The system makes communication and intervention easier, says Rohit R. Gupta, MD, Director of the Night Intensivist Coverage Service, Institute for Critical Care Medicine. “For example, if they are making adjustments to a patient’s ventilator at Mount Sinai Queens during the consult, we can see in real time what those changes are doing to his breathing pattern, to his oxygen numbers, to his blood pressure.”
Dr. Gupta described a case involving a woman who had ingested a toxic household chemical. She had seizures in the Emergency Department at Mount Sinai Queens and was taken to that hospital’s ICU, which contacted Dr. Gupta for a consultation at about 2 am. “Poisoning with this particular chemical is not very common,” Dr. Gupta says. “Fortunately we have experience with it, so we were able to discuss what to keep an eye out for.” The team was advised to avoid certain antibiotics that could predispose the patient to more seizures, and to carefully manage fluids because of the risk of kidney damage.
“These consults are reassuring for both sides,” Dr. Gupta says, since they make physicians at The Mount Sinai Hospital well aware of patients who might need to be transferred. In this case, the patient was stabilized and remained at Mount Sinai Queens, where she made a “very good recovery” in a few days, he says.
Physicians have used Tele-ICU about twice a week since it was launched in March 2019, says Cameron R. Hernandez, MD, Chief Medical Officer and Vice President for Medical Affairs, Mount Sinai Queens. “We have found that it’s nice to work in teams, to have that support when there is a difficult diagnosis that you don’t often see,” he says.
Telemedicine programs like Tele-ICU are gaining traction throughout the nation as a way to efficiently share the expertise of specialists with community hospitals or hospitals in underserved rural areas, says Patrick Healy, MBA, Associate Director of Clinical Innovation, Mount Sinai Health System, who was the project manager of the system. “There is so much value in seeing the patient remotely,” says Robbie Freeman, MSN, RN, Vice President of Clinical Innovation. “In the case of The Mount Sinai Hospital and Mount Sinai Queens, Tele-ICU provides a fuller picture of the patient’s condition, to make sure the right resources are in place at the right time.”