PURPOSE: Providing around-the-clock intensivist-led care is considered the “gold standard” for improving ICU outcomes. However, the shortage of intensivists limits the current capability to provide this level of care in individual hospitals, let alone in a multi-hospital system. Our health system implemented the eICU® tele-intensivist program as a mechanism to leverage our limited intensivists, and standardize clinical practice and processes to our seven hospitals. We then evaluated changes in ICU outcomes over time to asses the impact of these programmatic changes.
METHODS: We compared Apache III severity-adjusted ICU and hospital mortality rates and ICU and hospital length of stay (LOS) for this seven-hospital health system (84 ICU beds) over five quarters (2006-2007). Mortality was examined with logistic regression controlling for predicted mortality and LOS was compared with a K-Wallis and nptrend (non-parametric trend analysis) test to look for changes over time.
RESULTS: 3692 ICU patients were severity-adjusted (Apache III score quarterly range 44.5-51.4) and compared across five quarters (Q1 2006 to Q1 2007). Severity-adjusted ICU mortality went from 1.0 to .68, hospital mortality from .95 to .77, ICU LOS from 1.18 to .96 and hospital LOS from 1.09 to .84. Severity-adjusted ICU and hospital mortality (p=0.02 and p<0.001 respectively) and ICU and hospital LOS data (both=p<0.001) were significantly reduced over time.
CONCLUSION: Implementation of a remote ICU care program enabled provision of around-the-clock intensivist monitoring for all ICU patients in our health system. It also allowed us to centralize best practice oversight, and improve compliance of these best practices. These changes in ICU care correlated with reduced mortality and improved operational performance, as reflected in decreases in both ICU and hospital LOS.
CLINICAL IMPLICATIONS: Centralized remote care can be used to leverage intensivist resources across multiple hospitals and this correlates with improved outcomes. ICU and hospital LOS reductions should be associated with financial benefit.
DISCLOSURE: Gregory Howell, No Financial Disclosure Information; No Product/Research Disclosure Information