Penn State Health has integrated respiratory therapy into its virtual intensive care services at two medical centers, effective May 1. This new addition aims to provide an extra level of expertise and support to manage critically ill patients across the health system.

“The addition of virtual respiratory care will support bedside care teams when caring for complex patients or when a respiratory therapist may be caring for other patients or not be immediately available,” says Will Hazard, MD, director of virtual intensive care, or vICU, in a release. “In addition, tasks such as charting, alarm management, and best practices can, to a large extent, be performed virtually, offloading some of these tasks from the in-person respiratory therapist.”

Virtual respiratory therapy increases Penn State Health’s capacity to serve a larger patient population, particularly in the midst of a national shortage of certified respiratory therapists, according to a release from Penn State Health.

“A respiratory therapist will staff the virtual ICU, along with other vICU providers, from 11 pm to 7 am seven days a week, supporting care for patients and communicating with bedside staff through two-way audio/video connections,” says Dana Stauffer, respiratory therapy administrative director at Penn State Health Milton S. Hershey Medical Center, in a release.

Initially, the Milton S. Hershey Medical Center and Penn State Health Lancaster Medical Center will provide the new virtual service, with planned expansion to other Penn State Health medical centers. Penn State Health assumed virtual ICU operations internally last fall, including assistance with new admissions documentation, pain reassessment, quality initiative audits during rounding, predictive analytics to gauge high-risk patients, and monitoring of other unit patients during a code.

“Virtual respiratory therapists increase accessibility to care, providing layered services in hospitals that may be challenged to fully staff respiratory therapy, particularly during the night,” Hazard says in the release. “The virtual respiratory therapy services will enable us to break down geographical barriers to quality respiratory care that may be influenced by local staff shortages in regions Penn State Health serves.”

According to Stauffer in the release, “The virtual service can range from helping to manage a difficult-to-ventilate patient to monitoring oxygen administration to a patient experiencing shortness of breath, as well as ventilator management and review of new patients’ respiratory issues. In addition, the focus and continuity of virtual respiratory therapists may detect subtle patient changes, prompting interventions that can result in better patient outcomes.”

Virtual services streamline communications among members of a patient’s care team, improving overall quality and continuity of care, Hazard notes.

“This function will help to facilitate weaning from mechanical ventilation, troubleshoot alarms, alternate and adapt to individual patients with different modes of ventilation, and help to facilitate continuing patient engagement and education—extremely important but also time-consuming and challenging functions, especially when patient care demands are high,” says Hazard in the release. “In addition, the service provides cost-effective, high-quality respiratory care to hospitals that may have varying acuity and patient census. This program will allow us to immediately scale respiratory therapy services at a moment’s notice to address increased workload.” 

Efforts to add respiratory therapy to the vICU program began in the fall. The work required review of department workflow, shadowing of registered nurses in the virtual care program, and familiarizing respiratory therapy team members with the software used by the vICU. CLEW Medical’s cloud-based virtual ICU platform uses artificial intelligence-based predictive analytics, providing clinicians with comprehensive information on current and predicted patient conditions.

All services provided through Penn State Health’s virtual ICU coordinate with bedside providers, with intensive-care clinicians connecting with on-site staff through technology. Specially trained critical-care nurses remotely provide around-the-clock monitoring and regular check-ins with patients, the technology immediately alerting the bedside care team of urgent situations. During the night, the vICU expands its scope by using critical-care physicians to treat acute issues that may arise, stabilizing patients, and maintaining care plans.

The benefits of virtual intensive care include prompt evaluations in collaboration with the bedside care team, access to clinical expertise regardless of patient location, and an added layer of safety, resulting in peace of mind for patients and their family members. The system maintains patient privacy by notifying room occupants with a doorbell-style chime indicating the camera has been turned on.

Photo caption: Susan Richwine, a registered nurse in Penn State Health’s Virtual Intensive Care Unit, checks the vitals of a patient. 

Photo credit: Penn State Health