Inside the Troubling Rise of TeleICUs

It was the middle of the night in the intensive care unit (ICU) of Island Hospital in Anacortes, Wash., and a patient was hallucinating and in withdrawal from alcohol. The Ativan he’d been given wasn’t enough to lower his heart rate, and Joyce Selph, a longtime nurse, was called over to assist. The protocol, she knew, was to call the attending physician and figure out next steps, but there was a problem. The hospital used a teleICU model, in which doctors staffed the ICU during the day, but only remote doctors were available overnight, via computer screen. Selph and the other nurses had tried to reach the teleICU doctor, but no one answered the calls.There was no one else to ask, and the patient was rapidly deteriorating. So Selph, who had been a nurse for more than 30 years, did what she assumed a doctor would do; she started the patient on Precedex, a medication that can help sedate a patient. Giving medication without a doctor’s orders risked her license, Selph knew, but not doing anything risked the patient’s life. The patient survived. Selph was so disturbed by the incident that she complained to her nursing supervisors and to the hospital’s administration that having a doctor...