Education, Research, and Quality Improvement |

Workload Update on the Most Rural Tele-Intensive Care Program FREE TO VIEW

Edward Zawada*, MD; Srinivas Gangineni, MD; Pat Herr, CCRN; Michael Heisler, MD; Scott Deppe, MD; Avera eServices Research Group
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Avera McKennan Hospital & University Health Center, Sioux Falls, SD

Chest. 2012;142(4_MeetingAbstracts):548A. doi:10.1378/chest.1384421
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SESSION TYPE: Outcomes/Quality Control Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Our tele-intensivist program has been operating for 90 months and is considered the most rural of similar programs across the nation, serving 32 hospitals in 6 mostly sparsely populated North Central states in the upper Midwest. We have previously published reduction in ICU/hospital mortality and reductions in ICU/hospital length of stay after initiation of this service which has translated to increased throughput. As an example, the program covers 132 beds at capacity, but the average census has been 59.2 beds per day over the past 6 months despite the high number of daily admissions of 22.1 per day. Our program has had the highest number of interventions per month of all the eICU programs at an average of 1213 each month for the last 6 month period. This high number reflects the high demand for our interventions by our subscribing hospitals.

METHODS: After each order was written, the Intensivist scored the intervention as major, intermediate, or minor. The top five most numerous major interventions are shown in Table 1.

RESULTS: Table 1 (1360 Interventions) Electrolyte management 8% (including hyper/hypokalemia) Respiratory failure management 7.8% Shock 7.6% Hypoxemia 6.8% Hypotension 6.7% The top 5 intermediate interventions are shown in Table 2, and finally, the top minor interventions are shown in Table 3. Table 2 (3012 Interventions) Communication with families and providers 25.7% Electrolyte management 14.4% Hypotension 7.5% Diagnostic test evaluation 7% Arrhythmia management 5.6% Table 3 (1178 Interventions) Communication 60.7% Electrolytes 14.2% PRN meds 8.1% Agitation control 5.3% Ordering tests 4.8%

CONCLUSIONS: It can be concluded that tele-intensive care is an active, welcomed, and needed service in the rural setting. Electrolyte management is a common intervention which has in recent literature been shown to be an important factor in outcome of acute illness such as abnormal potassium levels in acute myocardial infarction.

CLINICAL IMPLICATIONS: The welcome, frequent interventions we believe are an important factor in our previously published improved quality measures and outcomes in rural hospitals.

DISCLOSURE: The following authors have nothing to disclose: Edward Zawada, Srinivas Gangineni, Pat Herr, Michael Heisler, Scott Deppe, Avera eServices Research Group

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Avera McKennan Hospital & University Health Center, Sioux Falls, SD




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