Critical Care |

Novel Critical Care Staffing and Support Solutions for a Small Naval Hospital FREE TO VIEW

Alexandra Perry, MD; Konrad Davis, MD; Matthew Tadlock; Peter Park, MD
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Naval Medical Center San Diego, San Diego, CA

Chest. 2015;148(4_MeetingAbstracts):252A. doi:10.1378/chest.2220930
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SESSION TITLE: Critical Care Posters III

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The US Navy operates several smaller medical facilities throughout the globe. Many of these facilities have limited critical care capability. Naval Hospital Camp Pendleton is one such facility. Intensivist staffing of these facilities can be challenging. Requirements for deployment and permanent change of station (PCS) can exaccerbate shortfalls in manning. However lack of Intensivist involvement has been associated with worse outcomes and increased disengagements out of network. Current BUMED policy requires Intensivist involvement with all ICU patients.

METHODS: Naval Medical Center San Diego established a tele-critical care support solution to address this staffing challenge. During periods of tele-critical care (TCC) coverage, the remote ICU attending would be immediately available to NHCP. Teaching and patient care rounds were conducted at least daily with the primary team and Nursing using high-definition VTC technology. All documentation occurred in the remote hospital’s EMR. Several Care protocols were established to facilitate uniform best practice adherence.

RESULTS: During the 8 months prior to program operation, 12 patients were disengaged for civilian critical care. During the first 8 months of program operation, the TCC unit conducted a total of 75 consult, resulting in no disengagement of inpatient care. This included a 3 month period with no on-site Intensivist staffing. The TCC program also supports the Family Practice residency at NHCP through teaching during tele-ICU rounds. The quality of care is improved both through the more rapid transfer of patients who require a higher level of care, and the Intensivist comanagement of patients kept at NHCP. The value of care increased through both quality, and the cost savings associated with the avoidance of unnecessary transfers and decreasing loss of care to network.

CONCLUSIONS: Leveraging new technology to provide remote care for our sickest beneficiaries has been proven a successful solution to the dilemma of limited Intensivist staffing.

CLINICAL IMPLICATIONS: Given the operation of several small hospitals in the US Navy with Intensivist staffing challenges similar to NHCP, more wide-spread adoption of this model is worth exploration. This model may be generalizable to smaller rural hospitals.

DISCLOSURE: The following authors have nothing to disclose: Alexandra Perry, Konrad Davis, Matthew Tadlock, Peter Park

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