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Closing the Door to Tele-ICU: Analysis of Outcomes Before and After Closing a Single ICU to Tele-Medicine FREE TO VIEW

Sumit Mukherjee, MD; Saiprasad Narsingam, MD; Majdi Hamarshi, MD; Zaheer Ahmed, MD
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University of Missouri Kansas City, Kansas City, MO

Chest. 2015;148(4_MeetingAbstracts):222A. doi:10.1378/chest.2265062
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SESSION TITLE: Critical Care Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM

PURPOSE: Staffing models for ICUs in the United States have been well studied, however continue to vary widely. Tele-ICU, or eICU, is a staffing model that provides a cost-effective solution to meet the growing demands of critical care medicine. While many studies have looked at the effects of implementing tele-ICU technology, no prior studies have evaluated patient outcomes after discontinuing tele-ICU support in an intensive care unit.

METHODS: We conducted a retrospective study in a single 18-bed ICU that utilized tele-ICU monitoring until April of 2014. At that point, the hospital changed from a low intensity staffing model supported by tele-ICU, to a high intensity staffing model unsupported by tele-ICU. Charts were reviewed on all patients who were admitted from July-December of 2013, when tele-ICU monitoring was in place, and from July-December of 2014, after tele-ICU monitoring was discontinued. Patient demographics, diagnosis, length of stay (LOS), all cause mortality, and days on mechanical ventillation were extracted for both groups.

RESULTS: A total of 1090 charts were reviewed and 1085 patients were included in the study. There were 549 patients admitted from July-December of 2013, the tele-ICU intervention period, and 536 patients admitted from July-December of 2014, after tele-ICU monitoring was discontinued. ICU mortality increased from 5.4% prior to the discontinuation of tele-ICU to 8.0% after discontinuation, but this was not statistically significant (P=0.08) (RR=0.68, 95% CI=0.43 to 1.06). Mean ICU length of stay was decreased by 0.7 days (95% CI=0.13 to 1.31). Hospital LOS was decreased by 0.18 days (95% CI= -0.69 to 1.06). Intubated patients had 0.85 less days on mechanical ventillation in the tele-ICU intervention group (95% CI -0.78 to 2.49).

CONCLUSIONS: This study demonstrates statistically signifcant increases in ICU length of stay in adults after discontinuing tele-ICU intervention. These findings document that in a single community ICU, there was no statistical significance between the two groups for days on mechanical ventillation and mortality.

CLINICAL IMPLICATIONS: These findings suggest there are benefits to utilizing a tele-ICU in a low intensity staffing model and this model is non-inferior to a high intensity staffing model.

DISCLOSURE: The following authors have nothing to disclose: Sumit Mukherjee, Saiprasad Narsingam, Majdi Hamarshi, Zaheer Ahmed

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