Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, West Virginia University Medicine, Morgantown, WV, USA.
Jon Michael Moore Trauma Center, West Virginia University Medicine, Morgantown, WV, USA.
Am Surg. 2023 May;89(5):1533-1538. doi: 10.1177/00031348211062653. Epub 2021 Dec 27.
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.
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 < .04.
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 ( = .03). Transfers to TC increased from 49.6 to 62.0% ( = .001). Critical access hospital average monthly census and average monthly inpatient days increased (69 to 130 ( < .0001) and 158 to 319 ( < .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.
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.
远程咨询为特定问题和单点提供了获得专业护理的途径。eICU 模式利用远程监测和医嘱，但具有显著的财务负担。我们为日常工作开发了一个虚拟重症监护病房 (VICU)，由一名重症监护医师与当地医生一起工作。目的是扩大急症医院（CAH）的急性护理能力。本研究评估了对 CAH 和系统的影响。
CAH 组建了一个由医院医师领导的 ICU 团队，负责 ICU 的工作。CAH ICU 团队每天通过安全视频链接进行查房，与位于大学、三级医疗中心 (TC) 的重症监护医师进行咨询。在实施前后（2018 年 4 月至 2019 年 3 月）进行了回顾性分析。Fisher 确切检验用于比较干预前后，差异有统计学意义（ <.04）。
实施 VICU 后，有 265 例初始每日咨询和 35 例随访咨询。每月转入更高级别护理的患者从 63 例减少至 57 例（ =.03）。转往 TC 的患者从 49.6%增加到 62.0%（ =.001）。急症医院的月平均入住人数和月平均住院天数增加（从 69 人增加到 130 人（ <.0001）和从 158 人增加到 319 人（ <.0001））。急症医院的医生报告称，由于该计划，他们对收治 ICU 和非 ICU 患者的舒适度有所提高。总启动成本为 5180 美元。CAH 聘请了 11 名医生。没有意外死亡。
VICU 的实施带来了新的 CAH 就业机会。CAH 的住院人数和收入（ICU 和非 ICU）增加，而转出系统的患者减少。
