Hospital of the University of Pennsylvania
University of Pennsylvania
Hospital of The University of Pennsylvania
Introduction: Demand for intensive care unit (ICU) resources is predicted to expand as the population ages and life support technologies improve. Intensivists frequently must arbitrate ICU beds to the most acutely ill patients leaving little room for those less sick.
Hypothesis: We hypothesized collaborative care between a Surgical Critical Care Service (SCCS) and a Telemedicine ICU Service (TIS) could provide virtual ICU (VICU) coverage for postoperative patients managed in Post-Anesthesia Care Unit (PACU) beds during times of peak ICU bed demand.
Methods: We performed a retrospective review of all patients seen by the SCCS from 01/08-07/11. Patients were divided into two groups: those admitted directly to the SICU vs. those admitted to a VICU bed. The VICU group was managed jointly by a SCCS and a TIS, utilizing four PACU beds at a location remote from the SICU for ‘surge capacity’. VICU patients were managed by a SCCS nurse practitioner and an in-house intensivist from 07:00-18:59 and by a TIS from 19:00-06:59. Patients with lower-intensity postoperative needs were preferentially boarded in VICU. Patients were boarded in VICU beds until SICU beds became available or until patients’ critical care needs resolved. Groups were compared using Kruskal-Wallis or Chi squared as appropriate. Statistical significance was set at p=0.05.
Results: Compared to those in the SICU group (n=6932), patients in the VICU group (n=1046) were slightly older (median age 60 (IQR47-69) vs. 58 (IQR 44-70) years, p = 0.01) but had lower APACHE II scores (median 10 (IQR7-14) vs. 15 (IQR 11-21), p <0.001). The average time VICU patients spent in PACU was 13.7 +/- 9.6 hours. In the VICU group, 761 (72.5%) of patients were able to be transferred directly to the ward from the PACU; 288 (27.5%) required subsequent SICU admission. All patients in the VICU group were alive upon ICU discharge or transfer to the floor; mortality in the SICU cohort was 5.3%.
Conclusions: A collaborative care model between SCCS and TIS may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.