Cost Effective Virtual Intensive Care Unit Expanding Capabilities in Critical Access Hospitals
Cost Effective Virtual Intensive Care Unit Expanding Capabilities in Critical Access Hospitals
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DOI：
10.1177/00031348211062653
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发表时间：
2021-12-27
期刊：
影响因子：
1
通讯作者：
Wilson, Alison M.
中科院分区：
文献类型：
--
作者：
Dudas, Lauren M.;Bardes, James M.;Wilson, Alison M.
背景远程会诊为特定问题和单个时间点提供专业护理。eICU模型利用远程监控和订购，但具有显著的财务负担。我们开发了一个虚拟重症监护病房（VICU）的重症监护医师与当地医生的日常输入。目的是扩大危重病医院（CAH）的急诊护理能力。本研究评估了对CAH和系统的影响。方法CAH成立了一个ICU团队，由一名住院医师领导，负责重症监护室（ICU）。CAH ICU团队每天通过安全的视频链接与大学三级护理中心（TC）的重症监护医生进行会诊，提供护理。实施前后6个月（2018年4月-2019年3月）进行回顾性分析。Fisher精确检验用于比较干预前后的差异，P <0.04。结果VICU实施后，每日初诊265例，随访35例。每月转移到更高级别的护理从63下降到57（P =.03）。转移到TC从49.6%增加到62.0%（P =.001）。关键访问医院平均每月人口普查和平均每月住院天数增加（分别为69至130（P <.0001）和158至319（P <.0001））。关键访问医院的医生报告说，由于该计划，增加了ICU和非ICU患者的舒适度。总启动成本为5180美元。CAH聘请了11家供应商。未发生非预期死亡。讨论VICU的实施导致了新的CAH工作。CAH经历了增加住院人口普查和收入（ICU和非ICU），而减少病人转出系统。
Background Tele-consults provide access to specialized care for a specific question and single point in time. eICU models utilize remote monitoring and ordering but have significant financial burden. We developed a virtual intensive care unit (VICU) for daily input of an intensivist working with local physicians. The purpose was to expand the acute care ability of the critical access hospital (CAH). The study evaluates the impact on the CAH and system. Methods The CAH developed an ICU team, led by a hospitalist, who staffed the intensive care unit (ICU). The CAH ICU team rounds daily via a secure video link to provide care in consultation with intensivists based at a university, tertiary care center (TC). A retrospective analysis was conducted 6 months before and after implementation (4/2018-3/2019). Fisher's exact test was used to compare pre- and post-intervention with significance at P < .04. Results After VICU implementation, there were 265 initial daily and 35 follow-up consults. Monthly transfers to a higher level of care decreased from 63 to 57 (P = .03). Transfers to TC increased from 49.6 to 62.0% (P = .001). Critical access hospital average monthly census and average monthly inpatient days increased (69 to 130 (P < .0001) and 158 to 319 (P < .0001), respectively). Critical access hospital physicians report increased comfort to admit ICU and non-ICU patients due to the program. The total startup cost was $5180. CAH hired 11 providers. There were no unanticipated deaths. Discussion VICU implementation resulted in new CAH jobs. The CAH experienced increased inpatient census and revenues (ICU and non-ICU) while decreasing patients transferred out of the system.