Impact of Telemedicine Monitoring of Community ICUs on Interhospital Transfers.

Crit Care Med 2017 Aug;45(8):1344-1351

1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.2Mayo Clinic Health System-Reporting and Analytics Team, LaCrosse, WI.3Division of Biostatistics, Mayo Clinic, Rochester, MN.4Division of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Objectives: To study the effects of tele-ICU monitoring on interhospital transfers from community-based ICUs to the quaternary care hospital at Mayo Clinic, Rochester, MN.

Design: This is a retrospective review of data on interhospital transfers comparing trends prior to tele-ICU implementation to those following implementation.

Setting: Tele-ICU programs are increasingly utilized to fill resource gaps in caring for critically ill patients. How such programs impact population and bed management within a healthcare system are not known. Mayo Clinic serves as quaternary referral care center for hospitals in the region within the Mayo Clinic Health System. In August 2013, we implemented tele-ICU monitoring at six Mayo Clinic Health System hospital ICUs.

Subjects: All adult ICU admissions during the study period (preimplementation phase: January 1, 2012, to December 31, 2012; and postimplementation phase: January 1, 2014, to December 31, 2014) in any of the six specified community ICUs were included in the study.

Measurements And Main Results: Interhospital transfers significantly increased post institution of tele-ICU (p = 0.040) and was attributed primarily to transfer from less specialized ICUs (p = 0.037) as compared with more resource-intensive ICUs (p = 0.88). However, for such patient transfers, there were no significant differences before and after severity of illness scores, ICU mortality, or inhospital mortality.

Conclusion: In a regional healthcare system, implementation of a tele-ICU program is associated with an increase in interhospital transfers from less resourced ICUs to the referral center, a trend that is not readily explained by increased severity of illness.

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Source
http://dx.doi.org/10.1097/CCM.0000000000002487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5511079PMC
August 2017
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