A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details

Spyridon Fortis, Craig Weinert, Robyn Bushinski, Alison Greiner Koehler, Greg Beilman
Journal of the American College of Surgeons 2014, 219 (4): 676-83

BACKGROUND: Improving the efficiency of critical care service is needed as the shortfall of intensivists is increasing. Standardizing clinical practice, telemedicine, and organizing critical care service at a health system level improves outcomes. We developed a health system Critical Care Program based at an academic medical center. The main feature of our program is an intensivist who shares on-site and telemedicine clinical responsibilities. Tele-ICU facilitates the standardization of high-quality critical care across the system. A common electronic medical record made the communications among the ICUs feasible. Combining faculty from medical and surgical critical care divisions increased the productivity of intensivists.

STUDY DESIGN: We retrospectively reviewed the administrative database data from 2011 and 2012, including mean census, number of transfers, age, sex, case mix index, mortality, readmissions, and financial data.

RESULTS: The Critical Care program has 106 adult ICU beds; 54 of those beds can be managed remotely using tele-ICU based at the main University hospital. The mean midnight census of the system for 2012 was 69.44 and total patient-days were 34,406. The capital cost of the tele-ICU was $1,186,220. The annual operational cost is $1,250,112 or $23,150 per monitored ICU-bed. Unadjusted mortality was 6.5% before and 4.9% after implementation (p < 0.0002).

CONCLUSIONS: We describe a novel health system level ICU program built using "off the shelf" technology based on a large University medical center and a tele-ICU with a full degree of treatment authority across the system.

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