Some Ascension ICUs Have No In-Person Critical Care Physicians
Ascension Wisconsin's smaller intensive care units now staff specialists via video call.
Hospital waiting area. (Public Domain)
Some smaller Ascension hospitals around Milwaukee have opted to only staff critical care physicians by video call in some intensive care units — concerning hospital staff and raising questions around patient care.
Critical care physicians, known as intensivists, have no longer been physically present at some of Ascension Wisconsin’s smaller hospitals in the Milwaukee area as of May 1. The change was first reported by the Milwaukee Journal Sentinel. The hospital system did not confirm to the Journal Sentinel or WPR which hospitals are moving to this telemedicine model, but the Journal Sentinel reported sites undergoing this change include locations in Mequon, Brookfield and Franklin.
The affected intensive care units still staff on-site hospital medicine doctors, known as hospitalists. But hospitalists aren’t specialized in providing critical care, and may not be trained to perform certain highly-specialized, time-sensitive procedures.
Staff also expressed concern to the Journal Sentinel about communication surrounding the changes and who would respond in case of an emergency in one of the affected ICUs.
In a written statement provided to WPR, Ascension Wisconsin said telehealth technology is used in other Wisconsin ICUs and pushed back on concerns about the availability of time-sensitive care in emergency situations.
“There are protocols in place today to manage emergency situations and these will remain constant, utilizing in-house, 24/7 clinicians, including hospital medicine physicians, emergency medicine physicians and practitioners, critical care nurses and respiratory therapists, as well as ICU-trained advanced practice providers and intensive care physicians,” a spokesperson for Ascension Wisconsin wrote.
Ascension Wisconsin faced backlash after announcing plans for a broader effort last year. Last summer, the system had planned to replace local physician groups staffing its ICUs with a staffing firm that would have provided critical care with telemedicine doctors or nurse practitioners.
How do tele-ICUs work?
Dr. Ellie Golestanian is an associate professor in the division of pulmonary and critical care medicine at the UW School of Medicine and Public Health, whose work focuses on tele-ICU services. She told WPR’s “Wisconsin Today” that up to 1 in 5 ICU beds nationwide have some involvement with telehealth doctors.
“It’s not simply a critical care physician answering a phone call on their mobile (phone) or even by some sort of video system,” Dr. Golestanian said. “It’s an entire setup that has its own specialized software that pulls in real-time patient data for us to review constantly. So we can look at patients’ charts, their labs, their imaging, vital signs, ventilator settings, their clinical trends.”
Dr. Golestanian works with UW Health to offer tele-ICU services to small, often rural hospitals around the state — partially due to a shortage of critical care physicians nationally and in Wisconsin. But she said a key part of effectively providing telehealth options in an ICU is to have trained staff and clearly defined procedures in place.
“At the very start of taking on a partnership with a new site, we clear these hurdles,” Dr. Golestanian said. “We make sure that somebody is there who can do these things, and if, after a patient is intubated, we determine that the resources and bedside staff are not there to take care of an intubated patient and their mechanical ventilation, then we help them make arrangements to transfer the patient out.”
In response to potential concerns from patients or family members about being monitored from an off-site specialist, Dr. Golestanian said these doctors can have direct conversations with patients explaining their role and how they fit into their care.
“It’s important to know that it’s not just one physician providing (tele-ICU) care,” Dr. Golestanian added. “We’re very much a team — usually a ratio of four highly qualified critical care nurses to one physician in addition to administrative staff and information technology staff, who ensure that everything is running smoothly and that we can answer questions, including to the family who may have questions for us.”
Some Ascension ICUs not staffing in-person critical care physicians was originally published by Wisconsin Public Radio.
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