Implementation of Tele-Critical Care at General Leonard Wood Army Community Hospital

Introduction: Tele-Intensive Care Unit (tele-ICU) is care provided to critically ill patients by remote clinicians using audio, and video communications and network resources to access real-time patient information from physiologic monitors and the electronic medical record. Tele-ICU has been demonstrated in civilian healthcare to reduce mortality, improve care quality and safety, decrease intensive care unit (ICU) length of stay (LOS) and ventilator days, and save money. General Leonard Wood Army Community Hospital (GLWACH) is a small medical treatment facility with limited resources with respect to subspecialists and ancillary services. Materials and Methods: In 2012, GLWACH identified the lack of board-certified critical care physicians and limited baseline critical care capabilities as gaps that reduced surgical opportunities, challenged critical skill sustainment, exposed potential patient safety issues, and resulted in costly patient transfers to network hospitals. To address these gaps, GLWACH partnered with the Baptist Health Tele-ICU Service, located in Little Rock, AR, to provide Tele-ICU services to its four-bed intensive care unit. Video Teleconsultation (VTC) equipment was installed in the ICU as was a vendor specific solution for accessing real-time patient vital signs and an "emergency" button. The emergency button functioned by turning on the VTC equipment and calling the Tele-ICU center in Little Rock immediately when pushed. To assess impact, hospital and ICU volume, acuity, case mix index, purchased care costs were monitored before and after implementation of the system. Additionally, a Safety Attitudes Questionnaire (SAQ) was administered before and after implementation. Results: The implementation of the tele-ICU program at GLWACH increased hospital and ICU patient volume, surgical patient volume, and patient complexity. Purchased care costs declined by 30% in the year following implementation and return on investment was $233,311 (19%). All measurements of the SAQ improved following implementation. Conclusions: These findings support the implementation of tele-ICU in the MHS as a cost-effective method to sustain readiness amongst critical care clinicians and improve safety culture in MHS hospitals.