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RELATIONSHIP BETWEEN LEVELS OF CONSULTATIVE MANAGEMENT AND OUTCOMES IN A TELEMEDICINE INTENSIVIST STAFFING PROGRAM (TISP) IN A RURAL HEALTH SYSTEM

Avera Health System, Sioux Falls, SD

PURPOSE: A TISP was initiated to improve the quality of care and patient safety in seriously ill patients hospitalized in a rural health care system of 4 main hospitals in the upper Midwest. The TISP shared the expertise of an experienced intensivist team including 24-hour vigilance of patients for early diagnosis and intervention to correct adverse clinical trends. An "open" model was chosen in which the attending physicians could choose the level of consultative management from three categories.

METHODS: Three levels of consultative management were available. Category I required the telemedicine intensivist team to intervene only for life-threatening emergencies or to appraise the primary attending of any adverse clinical trend. Category II allowed the intensivist team to adjust any existing therapy. Category III empowered complete clinical decision-making to the TISP.

RESULTS: Mortality was reduced 76.5% from that predicted by Apache III severity scoring for the hospital with the highest number of attending physicians choosing Category III management. In the hospital with mostly Category I consultation, the mortality was reduced 16 % from that predicted. Reduction of ICU length of stay was 33% vs. –2% in the two hospitals respectively. There was a significant difference in ventilator days per ventilated patients between the two hospitals. Significant differences between the two hospitals was seen in compliance with several evidence-based ICU therapies including DVT prophylaxis, stress ulcer prophylaxis, use of low tidal volumes, and beta-blocker use in acute coronary syndrome.

CONCLUSION: In a rural health care system greater discretion by a TISP to supervise and intervene in seriously ill patients results in improved outcomes.

CLINICAL IMPLICATIONS: In a rural setting where availability of intensivists and experienced critical care nursing is scarce, telemedicine intensivist consultation can improve outcomes.

DISCLOSURE: Edward Zawada Jr, None.