Evaluation of Change in Medication Regimen Complexity-ICU (MRC-ICU) Score Following Implementation of a Virtual...

Area of Science:

• Critical Care Medicine
• Health Services Research
• Pharmacoeconomics

Background:

• Telehealth in the Intensive Care Unit (Tele-ICU) aims to enhance patient outcomes and optimize the use of critical care resources.
• The impact of Tele-ICU on Medication Regimen Complexity-ICU (MRC-ICU) scores remains largely unexplored.
• Understanding this relationship is crucial for evaluating the comprehensive effects of Tele-ICU services.

Purpose of the Study:

• To evaluate the effect of Tele-ICU implementation on the MRC-ICU score.
• To describe the nature and frequency of pharmacist activities within the Tele-ICU setting.
• To assess changes in specific ICU bundled care metrics following Tele-ICU adoption.

Main Methods:

• Retrospective analysis of adult ICU encounters (≥24 hours) comparing pre- and post-Tele-ICU periods in a rural hospital system.
• Primary outcome: MRC-ICU score at 24 hours post-ICU admission.
• Prospective data collection on pharmacist interventions and categorization of encounters by clinical pharmacist review exposure.

Main Results:

• No significant difference in mean MRC-ICU score was observed between pre- and post-Tele-ICU encounters (P=0.5217).
• Post-intervention ICU encounters showed improved rates of VTE prophylaxis (P=0.001) and stress-ulcer prophylaxis (P<0.001), and reduced use of glycemic control agents (P=0.017).
• Tele-ICU did not significantly alter ICU length of stay or mortality. Pharmacist interventions were noted, but median MRC-ICU scores did not differ significantly between encounters with and without pharmacist review (P=0.0596).

Conclusions:

• Tele-ICU implementation did not significantly impact the MRC-ICU score at 24 hours post-admission.
• Improvements were observed in specific bundled care metrics, suggesting a positive effect on certain aspects of ICU care quality.
• A substantial proportion of ICU encounters may offer limited opportunities for impactful pharmacy interventions, highlighting a need for optimized pharmacist integration.