Telemedicine coverage for post-operative ICU patients.

Area of Science:

• Critical Care Medicine
• Health Services Research
• Telemedicine

Background:

• Increasing demand for intensive care unit (ICU) beds necessitates innovative solutions for surge capacity.
• Traditional ICU models face challenges in meeting peak demand periods.
• Exploring alternative care settings and collaborative models is crucial for optimizing resource allocation.

Purpose of the Study:

• To evaluate the safety and efficacy of a virtual intensive care unit (VICU) model in the post-anaesthesia care unit (PACU) for increasing ICU surge capacity.
• To compare patient outcomes and resource utilization between patients managed in a traditional surgical intensive care unit (SICU) and those in the VICU.
• To assess the feasibility of a collaborative care model involving surgical critical care and telemedicine ICU services.

Main Methods:

• Retrospective review of patients managed by the surgical critical care service from January 2008 to July 2011.
• Comparison of patients in the SICU versus a VICU established within the PACU.
• Analysis of patient demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, length of stay, and mortality.

Main Results:

• The VICU group (n=1037) had slightly older patients with lower APACHE II scores compared to the SICU group (n=6652).
• 72% of VICU patients were discharged directly to the floor, while 28% required SICU admission.
• All VICU patients were alive upon transfer from the PACU, with a 5.5% mortality rate in the SICU cohort.

Conclusions:

• A collaborative care model using a telemedicine ICU service in the PACU can safely provide surge capacity during high ICU bed demand.
• This model effectively facilitates the transfer of suitable patients to lower care levels, optimizing ICU resource utilization.
• Further research is warranted to identify specific patient populations that would most benefit from this VICU approach.