PURPOSE: Providing around the clock intensivist care to a rural health system represents a significant staffing challenge. Our health system implemented a tele-intensivist program in 2004 to leverage our limited intensivist staff and improve clinical outcomes. We have previously reported on the clinical benefits of our program (Chest Vol. 130:226S). However, the current healthcare environment requires that new technologies also save money to be sustainable. Length of stay (LOS) is the single most important determinant of hospital cost, and we hypothesized that this care delivery model would also reduce length of stay across our health system.
METHODS: This study compared severity-adjusted LOS (APACHE-III) one year before and two years following implementation of the tele-intensivist program. For the pre-period, 200 randomly selected ICU patients (50 charts from each quarter for four quarters prior to program activation) from the tertiary (24 beds) and each of 3 regional hospitals (10 beds, 10 beds, and 6 beds) were compared to continuous APACHE-III scoring in the post period. Data were analyzed using a rank sum test on the difference of expected and observed LOS.
RESULTS: ICU LOS ratios (observed/expected) pre and post were 1.13 and 0.60 (-46.8%) in the tertiary hospital, 1.35 to 0.86 (-36.4%), 1.42 to 0.93 (-34.7%) and 0.96 to 0.89 (-7.6%) in the regional hospitals. Hospital LOS ratios were 0.62 to 0.53 (-21%) in the tertiary hospital, 0.79 to 0.63 (-20.3%), and 0.67 to 0.62 (-7.4%), and 0.79 to 0.80 (1.4%) in the regional hospitals. Both ICU and hospital LOS were reduced (p<0.001) and across the health system were associated with an annual reduction in 4146 ICU days and 572 hospital days.
CONCLUSION: Remote telemedicine intensivist staffing reduces severity-adjusted ICU and hospital lengths of stay and is associated with a substantial number of saved days across the health system.
CLINICAL IMPLICATIONS: Further analyses are required to determine the etiology of saved days, but based upon LOS reduction our tele-intensivist program demonstrates a financial benefit.
DISCLOSURE: Edward Zawada, No Financial Disclosure Information; No Product/Research Disclosure Information