There are, says Dr. Brian Rosenfeld, about 5,500 physicians in the country specializing in intensive care -- but to staff every intensive-care unit around the clock would require about 35,000.
Without enough specialists to provide round-the-clock coverage, many ICUs are staffed by "intensivists" only during the day, with nurses and residents on evening and overnight shifts. Or those in smaller hospitals don't have specialists at all, and are supervised by other doctors.
"Less than half the ICU patients in this country ever interact with an intensive-care specialist," Rosenfeld said.
From this simple math came an idea. Then a study. Then a business.
And yesterday, that business, called IC-USA, announced its first deal -- to set up a telemedicine system to provide 24-hour, seven-day "intensivist" coverage for three intensive-care units in two Virginia hospitals. Rosenfeld, who is executive vice president and chief medical officer of IC-USA, declined to specify a dollar value on the five-year pact, beyond describing it as "multimillion dollar."
"Once we had the initial `ah-ha,'" said Rosenfeld's colleague, Dr. Michael Breslow, "being the academic creatures that we are, we did a clinical trial." That four-month trial, covering more than 200 patients at a hospital in the Baltimore area, found that adding telemedicine round-the-clock coverage to normal staffing reduced patient mortality by about 60 percent, reduced complications by 40 percent and reduced costs 30 percent.
Cost savings through telemedicine are not unusual, said Dr. Colin Mackenzie, a professor of anesthesiology involved with telemedicine experiments at University of Maryland Medical System. For example, Mackenzie said, UMMS stroke specialists have a telemedicine hookup to St. Mary's Hospital in Southern Maryland, "and when we reversed one patient who had a stroke, it paid for the entire system." UMMS also uses telemedicine for early treatment of patients being transported to its Shock Trauma Center, and is planning an extensive cancer telemedicine network in the state to be financed by the tobacco settlement.
While there are lots of applications being tested for telemedicine, IC-USA plans to stick to adult intensive care, said Robert Pfotenhauer, who came on board six months ago as president and chief executive officer.
"It's an $80 billion market, and no one else is doing this," he said.
Rosenfeld and Breslow formed the company after the encouraging trial, eventually leaving their intensivist jobs at Johns Hopkins Hospital to develop the idea -- and the business -- full-time. Breslow is executive vice president, research and development.
Under the deal signed yesterday, intensivists at Sentara Healthcare in Norfolk will still staff their ICUs the old fashioned way in the morning. But each of the specialists will also spend a few nights a month at an electronic command center -- an "EICU" -- supervising patients during hours when there is no intensivist on the unit.
The doctor in the EICU, which is in an office park in Norfolk, will monitor all three ICUs and will be assisted by a nurse, a clerk and a technical support person.
"We don't envision it will replace doctors," Rosenfeld said. "Some on-site supervision is still necessary." Aside from extending the hours supervised by an intensivist at hospitals that already have them, IC-USA sees the system providing services to rural hospitals that don't have intensive-care specialists.
Located in Emerging Technology Center in Canton, IC-USA now has 25 employees. Pfotenhauer said it expects to complete two other sales agreements by the end of the year.
He said hospitals can realize gross savings of $150,000 per year per intensive care bed -- netting about half that after paying IC-USA.
IC-USA supplies the hardware and training and the support staff for the EICU. Sentara will employ the doctors. There is no startup cost to the hospital; those are built into IC-USA's fees over the five-year period.