TeleNeuroICU: Expanding the Reach of Subspecialty Neurocritical Care

Abstract

Telemedicine is a rapidly growing field of medicine due to a combination of high-speed global telecommunication systems and accessibility of small, fast mobile computing platforms with bidirectional audiovisual camera capabilities. Teleneurology is a subset of telemedicine. TeleNeuroICU, one form of teleneurology, is the practice of virtually consulting on patients in the ICU setting with neurological and neurosurgical conditions. Given the current and future shortage of neurologists and neurointensivists, there is a high demand for TeleNeuroICU services around the globe and this is expected to increase in the future. This review summarizes the state of the art around the TeleNeuroICU practice for practitioners in the field, emerging research in this area, and new technologies and integrations that enhance the value of TeleNeuroICU to health care systems.

Keywords

telemedicine - neuro intensive care - intensive care unit - TeleNeuroICU - eICU

Note

Mayo Clinic does not endorse specific products or services included in this article.

Publication History

Article published online:
24 January 2022

• References

• 1 Craig J, Patterson V. Introduction to the practice of telemedicine. J Telemed Telecare 2005; 11 (01) 3-9
• 2 Keesara S, Jonas A, Schulman K. COVID-19 and health care's digital revolution. N Engl J Med 2020; 382 (23) e82
• 3 Temesgen ZM, DeSimone DC, Mahmood M, Libertin CR, Varatharaj Palraj BR, Berbari EF. Health care after the COVID-19 pandemic and the influence of telemedicine. Mayo Clin Proc 2020; 95 (9S): S66-S68
• 4 Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med 2020; 382 (18) 1679-1681
• 5 Freeman WD, Barrett KM, Vatz KA, Demaerschalk BM. Future neurohospitalist: teleneurohospitalist. Neurohospitalist 2012; 2 (04) 132-143
• 6 Smartphone Ownership Is Growing Rapidly Around the World, but Not Always Equally [Internet]. 2019 [cited February 8, 2021]. Accessed December 20, 2021 at: https://www.pewresearch.org/global/2019/02/05/smartphone-ownership-is-growing-rapidly-around-the-world-but-not-always-equally/
• 7 Cohen JK, Weinstock M. Health Care Future is Telemedicine [Internet]. 2019 [cited February 8, 2021]. Accessed December 20, 2021 at: https://www.modernhealthcare.com/care-delivery/health-system-ceos-say-healthcare-home-future
• 8 Freeman W, Rincon F, Vatz K. Teleneurointensive Care Unit (TeleNeuroICU): expanding the reach of subspecialty NeuroICU care. In: Teleneurology in Practice. 2015. https://link.springer.com/book/10.1007/978-1-4939-2349-6
• 9 Klein KE, Rasmussen PA, Winners SL, Frontera JA. Teleneurocritical care and telestroke. Crit Care Clin 2015; 31 (02) 197-224
• 10 Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force report: clinical implications for neurology. Neurology 2013; 81 (05) 479-486
• 11 Zhai Y. A call for addressing barriers to telemedicine: health disparities during the COVID-19 pandemic. Psychother Psychosom 2021; 90 (01) 64-66
• 12 Guzik AK, Martin-Schild S, Tadi P. et al. Telestroke across the continuum of care: lessons from the COVID-19 pandemic. J Stroke Cerebrovasc Dis 2021; 30 (07) 105802
• 13 Williams K, Markwardt S, Kearney SM. et al. Addressing implementation challenges to digital care delivery for adults with multiple chronic conditions: stakeholder feedback in a randomized controlled trial. JMIR Mhealth Uhealth 2021; 9 (02) e23498
• 14 Freeman WD, Vatz K. Abstracts from The American Telemedicine Association Nineteenth Annual International Meeting and Exposition. Telemedicine and e-Health Mary Ann Liebert, Inc., Publishers; 2014; 20 (05) A–1-A–144
• 15 Turning Night into Day: Globalizing Critical Care [Internet]. [cited February 14, 2021]. Accessed December 20, 2021 at: https://emorymedicinemagazine.emory.edu/issues/2018/fall/briefs/turning-night-into-day/index.html
• 16 Gobburu JVS. Future of pharmacometrics: predictive healthcare analytics. Br J Clin Pharmacol 2020; DOI: 10.1111/bcp.14618.
• 17 Philips eICU program [Internet]. [cited June 6, 2021]. Accessed December 20, 2021 at: https://www.usa.philips.com/healthcare/resources/landing/teleicu
• 18 Statutes & Constitution: View Statutes: Online Sunshine [Internet]. [cited February 8, 2021]. Accessed December 20, 2021 at: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0382/Sections/0382.009.html
• 19 Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EFM. Variability of brain death policies in the United States. JAMA Neurol 2016; 73 (02) 213-218
• 20 Matiello M, Turner AC, Estrada J. et al. Teleneurology-enabled determination of death by neurologic criteria after cardiac arrest or severe neurologic injury. Neurology 2021; 96 (15) e1999-e2005
• 21 Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005; 58 (04) 585-593
• 22 Mattei TA, Teasdale GM. The story of the development and adoption of the Glasgow Coma Scale: Part I, The early years. World Neurosurg 2020; 134: 311-322
• 23 Ely EW, Inouye SK, Bernard GR. et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286 (21) 2703-2710
• 24 Stienen MN, Geisseler O, Velz J. et al. Influence of the intensive care unit environment on the reliability of the Montreal Cognitive Assessment. Front Neurol 2019; 10: 734
• 25 NIH Stroke Scale. Accessed December 20, 2021 at: https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf
• 26 Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: The introduction of the Neurological Pupil index. Surg Neurol Int 2011; 2: 82
• 27 International Standards for Neurological Classification of SCI (ISNCSCI) Worksheet [Internet]. 2018 [cited June 6, 2021]. Accessed December 20, 2021 at: https://asia-spinalinjury.org/international-standards-neurological-classification-sci-isncsci-worksheet/
• 28 Kichloo A, Albosta M, Dettloff K. et al. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Fam Med Community Health 2020; 8 (03) e000530
• 29 Shachar C, Engel J, Elwyn G. Implications for telehealth in a postpandemic future: regulatory and privacy issues. JAMA 2020; 323 (23) 2375-2376
• 30 Yoon D. What we need to prepare for the fourth industrial revolution. Healthc Inform Res 2017; 23 (02) 75-76
• 31 Min J, Kim Y, Lee S, Jang T-W, Kim I, Song J. The fourth industrial revolution and its impact on occupational health and safety, worker's compensation and labor conditions. Saf Health Work 2019; 10 (04) 400-408
• 32 Freeman WD, Sanghavi DK, Sarab MS. et al. Robotics in simulated COVID-19 patient room for health care worker effector tasks: preliminary, feasibility experiments. Mayo Clin Proc Innov Qual Outcomes 2021; 5 (01) 161-170
• 33 Trombley MJ, Hassol A, Lloyd JT. et al. The impact of enhanced critical care training and 24/7 (Tele-ICU) support on Medicare spending and postdischarge utilization patterns. Health Serv Res 2018; 53 (04) 2099-2117
• 34 Avgousti S, Christoforou EG, Panayides AS. et al. Medical telerobotic systems: current status and future trends. Biomed Eng Online 2016; 15 (01) 96
• 35 Tian W, Fan M, Zeng C, Liu Y, He D, Zhang Q. Telerobotic spinal surgery based on 5G network: the first 12 cases. Neurospine 2020; 17 (01) 114-120
• 36 DOD's inaugural foray into 5G experimentation on track [Internet]. [cited June 6, 2021]. Accessed December 20, 2021 at: https://www.defense.gov/Explore/News/Article/Article/2462765/dods-inaugural-foray-into-5g-experimentation-on-track/
• 37 iSchemaView, Inc. Neuroimaging stroke software platform powered by AI [Internet]. [cited June 6, 2021]. Accessed December 20, 2021 at: https://www.rapidai.com/
• 38 Viz.ai Intelligent Care Coordination [Internet]. [cited June 6, 2021]. Accessed December 20, 2021 at: https://www.viz.ai/
• 39 Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother 2014; 60 (01) 61
• 40 Medical Research Council. MRC. MRC muscle scale - research - medical research council [Internet]. [cited June 6, 2021]. Accessed December 20, 2021 at: https://mrc.ukri.org/research/facilities-and-resources-for-researchers/mrc-scales/mrc-muscle-scale/
• 41 Roth EJ. NIH Stroke Scale. Encyclopedia of Clinical Neuropsychology. Cham: Springer International Publishing; 2018: 1-2
• 42 Vespa PM, Olson DM, John S. et al. Evaluating the clinical impact of rapid response electroencephalography: the DECIDE Multicenter Prospective Observational Clinical Study. Crit Care Med 2020; 48 (09) 1249-1257
• 43 Rubin MN, Barrett KM, Freeman WD. et al. Teleneurosonology: a novel application of transcranial and carotid ultrasound. J Stroke Cerebrovasc Dis 2015; 24 (03) 562-565
• 44 Stead LG, Wijdicks EFM, Bhagra A. et al. Validation of a new coma scale, the FOUR Score, in the emergency department. Neurocrit Care 2009; 10 (01) 50-54