Tele-ICU and Internet Healthcare Solutions for Hospital Intensive Care Units

According to incomplete statistics, there are currently over 100 million critically ill patients in China. Statistical analysis conducted by the Department of Critical Care Medicine at Yantai Muping Hospital of Traditional Chinese Medicine in Shandong Province revealed that among patients admitted to the ICU,Cardiovascular and cerebrovascular diseases account for the largest patient population., accounting for 38.36% of the total number of cases,The remaining causes, in descending order, include poisoning and severe trauma, multiple organ dysfunction, severe infection, and malignant tumors.

Given the reality of an imbalance between the supply and demand for intensive care resources, an increasing number of hospitals are turning their attention to tele-intensive care units (tele-ICUs). Examples include remote consultations between Wuyi County Hospital and Sir Run Run Shaw Hospital; the e-ICU implemented by Shaoxing Second Hospital for remote monitoring; and family video visits introduced in the respiratory infection ICU ward at West China Hospital.

They leverage modern medical IoT technology, a vast array of physiological vital signs monitoring sensors, internet technologies, and cloud platforms to implement a series of remote monitoring measures for ICU patients.

Due to variations in patient positioning and monitoring objectives, the generated patterns are diverse.

For example, aroundIn-hospitalICU mobile rounds and monitoring, centered aroundInter-hospital...with hospitals at the primary, community, and remote levels through teleconsultation to analyze and discuss patients' conditions and determine treatment plans; focusing on remote emergency guidance for ambulances, as well as withFamily Portalconnection, family members and patients conduct audio-video calls via remote video.

Among these is an emerging model of remote intensive care—Home ICU Ward, that is, equipping the patient's household with a monitor, allowing hospital physicians to conduct remote rounds and monitor the patient's condition in real time; however, this model primarily targetsEarly Intervention in Emergency Care. For example, the pilot ICU remote home ward program implemented by the Department of Critical Care Medicine at Shandong Provincial Hospital.

Compared with other options, it serves as an extension of hospital ICU services to the community, addressing the needs of certain patients and their families. According to estimates by research institutions, the total cost of the home ICU model is approximately one-third of that of inpatient care.

Currently, remote intensive care units are generally equipped with advanced modern medical devices, including non-invasive sensors, vital signs monitors, defibrillators, multifunctional ventilators, central monitoring systems, remote diagnostic systems, and remote consultation systems.

Next, we will discuss each of the four major models separately.

▼In-Hospital Mobile Ward Rounds and Monitoring

Since patients admitted to the ICU have the lowest immunity in the entire hospital and are most prone to complications and severe infections, external sources of infection should be avoided as much as possible.

Remote monitoring, as the name suggests, refers to healthcare professionals leveragingVital Signs Sensors, Remote Monitoring SystemsReal-time monitoring of patients' physiological status and direct provision of nursing services enable one-to-many surveillance, as exemplified by the ICU Remote Monitoring and Management System launched by Guangzhou Tianhe Hospital.

As real-time monitoring is required, monitoring personnel must continuously observe patients’ physiological parameters—such as electrocardiogram (ECG), blood pressure, respiration, and oxygen saturation—24 hours a day.

Among the more well-known examples is the ViSi Mobile vital signs monitor, developed by Sotera Wireless in San Diego, California. ViSi Mobile is a wearable sensor system that utilizes Wi-Fi technology, enabling physicians to remotely monitor patients’ vital signs via devices such as tablets or smartphones.

ViSi Mobile includes a wrist-worn device with display, a chest sensor, an arm-cuff blood pressure monitor, and a thumb sensor. These sensors enable physicians to continuously monitor patients’ blood oxygen saturation, blood pressure, heart rate, electrocardiogram (ECG), and skin temperature, providing intensive care unit (ICU)-level precision data.

In addition to patient monitoring, mobile ward rounds are also commonly used. Various materials, such as emergency response protocols for the Department of Critical Care Medicine and assessment criteria for critical care patients’ indicators, are integrated into mobile ward-round carts. These resources can be accessed instantly upon startup, facilitating timely review and learning by healthcare professionals. For example, the Central ICU of the Department of Critical Care Medicine at West China Hospital has implemented such mobile ward-round carts.

Certainly, the hospital also conducts multidisciplinary consultations for patients with complex and critical conditions. It is particularly well-suited for highly complex chest pain consultations. This approach significantly addresses issues such as nosocomial infections in ICU departments of large hospitals, super-resistant bacteria, and the high threshold of medical costs.

▼ Inter-hospital Consultation

It typically involves collaboration between large hospitals with concentrated high-quality medical resources and grassroots hospitals in remote areas with backward technology.

As previously reported by the media, for example, in May this year, the Department of Critical Care Medicine at Xiangyang Hospital of Traditional Chinese Medicine established a collaboration with Tongji Hospital in Wuhan, enabling remote “face-to-face” consultations among specialists, patients, and medical staff, along with activities such as remote teaching, remote ward rounds, and remote conferences.

Also well-known are three rural hospitals in the United States: Grinnell Regional Medical Center in Iowa, Providence Kodiak Island Medical Center in Alaska, and Union Hospital in Clinton. These institutions collaborate with central hospitals through tele-ICU consultation systems to address the shortage of rural physicians.

▼ Remote Emergency Medical Guidance on Ambulances

The Jiangsu City Emergency Medical Center has implemented a mobile emergency information system on its ambulances. This system enables real-time transmission of vital signs data, electronic medical record documentation, and remote consultations via audio and video.

In 2013, China Mobile’s Hangzhou Branch collaborated with the Hangzhou Emergency Medical Center to launch the “120” Emergency Medical Informatics Project. By leveraging 4G mobile network technology to connect with the emergency center’s servers, the project enabled the transmission of critical emergency information to the emergency center and hospitals, facilitating real-time audio-video communication and timely transfer of medical data.

▼Family-Side Visitation

ICU wards leverage internet video conferencing technology to enable families to conduct audio-video communication with patients in the Intensive Care Unit via the network, thereby eliminating infection and other medical risks associated with in-person contact.

However, remote visitation operations are divided into the family side and the patient side, with all patient-side operations performed by nurses on behalf of the patients.

The family side is divided into home/office and in-hospital.

Access the Central Hospital’s visitation portal from home or the office, locate the intended visitor in the visitation list, and click “Log In” to initiate a remote video consultation with the patient.

For inpatients, the hospital has established a dedicated family video visitation center equipped with video terminals, cameras, microphones, and television sets, enabling families to communicate via voice and video.

The patient-side operation is performed by a nurse, with a dedicated computer mounted on a mobile cart and equipped with a high-definition camera and microphone. The entire process is simple to operate and requires no software installation.

For example, in 2013, the Intensive Care Unit (ICU) of Shanghai General Hospital’s Songjiang South Campus launched a family video visitation area, replacing the traditional “semi-restricted” bedside visitation model with remote video visits.

These models are, in fact, interconnected and integrated with various remote solutions to provide services such as monitoring, visitation, and ward rounds. Examples include GoToMeeting, which is widely used for remote visitation systems in hospital ICUs; LiveUC, a software platform for remote medical consultations; and Vidyo, which is applied to remote monitoring.

According to a 2011 analysis by MedPage Today, the hospital mortality rate was 13.6% before the implementation of telemedicine systems and decreased to 11.8% thereafter, with an adjusted odds ratio for mortality of 0.40 (95% confidence interval [CI], 0.31–0.52). The analysis also showed that the average length of stay was reduced from 13.3 days to 9.8 days, with a hazard ratio of 1.44 (95% CI, 1.33–1.56).