Impact of a Structured Telemedicine Model With Advanced Care Practitioners in Rural Intensive Care

First Author(s)

• AS

  Arunima Sharma, MD

  LSU Health Shreveport
  Shreveport, Louisiana

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• AA

  Ajit Alexander, MD

  CRITICAL CARE CLINICAL FELLOW
  Louisiana State University Health Sciences Center, United States

  Disclosure information not submitted.
• RW

  Robert Walter, MD, MPH,

  Professor and Division Chief of Pulmonary and Critical Care Medicine
  Louisiana State University Health Sciences Center, United States

  Disclosure information not submitted.
• NM

  Nasim Motayar, MD

  Assistant Professor of Clinical Medicine
  n/a, United States

  Disclosure information not submitted.

Title: Impact of a structured telemedicine model with advanced care practitioners in rural intensive care

Introduction: The use of Tele-medicine has become a propitious trend in medicine. As healthcare needs in rural/urban areas are increasing, it is often offset by deficiencies in staffing and resources. In the setting of critical care, the introduction of advanced practice providers(APPs) has been shown to facilitate the improvement of patient care. There have been few studies that have demonstrated that the utilization of tele-ICU models in the augmentation of patient-oriented outcomes. In our model APPs were trained at a large academic medical center and deployed to a rural community hospital where they practiced on daily multi-disciplinary rounds and received guidance from intensivists from a large academic medical center.

Methods: We followed the impact of structured APP education program followed by multi-disciplinary rounds via telecommunication on case mix index(CMI) as a surrogate for acuity of care provided.

Results: A year prior to implementation of this program the case mix index for this 15 bed community ICU was 1.95. Subsequently 3 months after implementation of critical care APPs with telemedicine support the case mix improved to 2.33 (16.3% increase). We suspect this was due to (1) improved accurate documentation in the electronic medical record to reflect severity of illness (2)increased local physician confidence to accept care for higher acuity patients with a mixed local-satellite support.

Conclusion: Introduction of a structured telemedicine program with trained APPs resulted in preparedness to care for higher acuity patients as measured by CMI. Increased CMI has two major implications both in terms of compensation for the hospital and it also reflects the ability of the hospital to accommodate higher acuity patients. In an era where the focus has shifted on long term outcomes on patients and families, the effect of such programs potentially translates into the ability of these hospitals to keep patients closer to home while providing expert critical care services. Similar programs can be investigated in the future to improve patient quality of care, overall outcomes and overcome communication barriers reported in telemedicine between the host and satellite hospital providers.