Around three years ago, Valley Health – a regional health system based in rural Virginia was facing challenges while recruiting critical-care physicians for its flagship hospital and referral center.

That’s reflective of a nationwide challenge, with just half of acute-care hospitals with intensive-care beds boasting intensivist coverage, according to a recent assessment by the Society of Critical Care Medicine’s education committees. The shortage of critical-care physicians is likely to increase in the coming years. Demand for those services is projected to grow as the U.S. population ages.

Valley Health found that recruiting specialists in rural areas is a challenge. Dr. T. Glen Bouder, medical director of critical care at the system’s flagship Winchester (Va.) Medical Center said that the center faced with a demand for intensivist services and a slow and challenging rate of recruitment of physicians.

This put a strain on the hospital’s limited ICU staff, especially during night shifts. Staff had to allocate their attention to admissions and “putting out fires” in the ICU, rather than manage the other beds and prepare patients for discharge as soon as possible, Bounder said.

Thus, in 2017 the hospital decided to work with a clinical services provider focused on remote critical care, to monitor patients.

Winchester Medical Center now has just a single intensivist on-site at night, who’s charged with overseeing any admissions, emergencies or procedures.

Otherwise, an off-site care team from the company Advanced ICU Care remotely manages patients via video and audio equipment. The team comprising of intensivist including nurses and respiratory therapists, has access to hospital’s electronic health record system and electronic feeds of patient’s physiological data.

Bouder said now they have active management of patients at night on top of the usual care provided during the day.

In Winchester Medical Center’s first year using teleICU services, the hospital reduced its ICU mortality rate by 32% compared with outcomes predicted by the version of the Acute Physiology and Chronic Health Evaluation it uses, known as APACHE IVa. The hospital reduced its ICU length of stay by 34%.

It also saved costs, since without tele-ICU, the hospital would have had to continue to try to recruit three to four more intensivists for night shifts.