What services can a post-Intensive Care Unit (ICU) clinic telemedicine business provide to recently discharged patients to reduce readmissions?

From the Guidelines

For a post-ICU telemedicine clinic focused on reducing readmissions, you should provide comprehensive transitional care services including medication reconciliation, symptom monitoring, psychological support, and care coordination, as these services have been shown to address the vulnerable transition period and improve patient outcomes 1. To achieve this, start by conducting thorough medication reviews to identify potential interactions, adjust dosages, and ensure patients understand their regimens. Implement remote vital sign monitoring using devices that track blood pressure, heart rate, oxygen saturation, and weight, with clear parameters for when patients should seek immediate care. Some key services to consider include:

• Addressing post-intensive care syndrome (PICS) through regular mental health screenings and referrals for conditions like anxiety, depression, and PTSD
• Coordinating follow-up appointments with specialists and primary care providers, ensuring continuity of care
• Providing education about red flag symptoms specific to patients' conditions, such as shortness of breath, fever, or changes in mental status
• Offering nutritional guidance to address issues like malnutrition or dysphagia common after ICU stays
• Implementing a structured communication protocol with scheduled check-ins at 24-48 hours post-discharge, then weekly for 4-6 weeks, as recommended by recent guidelines 1. These services are effective because they address the vulnerable transition period when patients are adjusting to self-management after intensive hospital care, helping to identify complications early and ensuring treatment plan adherence, which can lead to reduced readmissions and improved patient outcomes 1. Additionally, a multidisciplinary team-based approach, including neurocritical care, neurosurgery, rehabilitation specialists, physiatrists, physical therapists, and speech therapists, can reduce length of stay and improve patient outcomes 1. Telemedicine interventions can also be used to extend coverage, improve compliance, and facilitate transfer, which can help reduce readmissions and improve patient outcomes 1.

From the Research

Important Services for Post-ICU Clinic Telemedicine

To reduce readmissions for patients recently discharged from the ICU, the following services can be provided:

• Transition of Care (TOC) Program: Implement a multifaceted TOC program that includes efforts at admission, predischarge, and postdischarge, as seen in the study by 2. This program can help reduce 30-day readmission rates.
• Telemedicine Coverage: Utilize telemedicine to provide coverage of intensive care units, which can improve access to and quality of critical care, as discussed in the study by 3.
• Evidence-Based Transitional Care Processes: Implement evidence-based transitional care processes, such as pre-discharge patient education and medication reconciliation prior to discharge, which have been shown to reduce readmissions, as seen in the study by 4.
• Increased Adherence to Best Practice Guidelines: Use telemedicine to increase adherence to best practice guidelines and indicators of process quality, which can improve the quality of care, as suggested in the study by 5.
• High-Intensity Intensivist Staffing Model: Implement a high-intensity intensivist staffing model using tele-ICU technology, which has been linked to improved mortality, complications, and costs, as discussed in the study by 6.

Key Components of Post-ICU Clinic Telemedicine

Some key components to consider when providing post-ICU clinic telemedicine services include:

• Clinical Staff Involvement: Having clinical staff involved in the TOC program is important for patient identification and interventions to reduce readmissions, as seen in the study by 2.
• Patient Education: Providing pre-discharge patient education can help reduce readmissions, as discussed in the study by 4.
• Medication Reconciliation: Performing medication reconciliation prior to discharge can also help reduce readmissions, as seen in the study by 4.
• Bridging Personnel: Having bridging personnel, such as inpatient social workers and dedicated case managers, can help facilitate the transition of care and reduce readmissions, as suggested in the study by 4.