Objectives: To study the effects of tele-ICU monitoring on interhospital transfers from community-based ICUs to the quaternary care hospital at Mayo Clinic, Rochester, MN.
Design: This is a retrospective review of data on interhospital transfers comparing trends prior to tele-ICU implementation to those following implementation.
Setting: Tele-ICU programs are increasingly utilized to fill resource gaps in caring for critically ill patients. How such programs impact population and bed management within a healthcare system are not known. Mayo Clinic serves as quaternary referral care center for hospitals in the region within the Mayo Clinic Health System. In August 2013, we implemented tele-ICU monitoring at six Mayo Clinic Health System hospital ICUs.
Subjects: All adult ICU admissions during the study period (preimplementation phase: January 1, 2012, to December 31, 2012; and postimplementation phase: January 1, 2014, to December 31, 2014) in any of the six specified community ICUs were included in the study.
Measurements and Main Results: Interhospital transfers significantly increased post institution of tele-ICU (p = 0.040) and was attributed primarily to transfer from less specialized ICUs (p = 0.037) as compared with more resource-intensive ICUs (p = 0.88). However, for such patient transfers, there were no significant differences before and after severity of illness scores, ICU mortality, or inhospital mortality.
Conclusion: In a regional healthcare system, implementation of a tele-ICU program is associated with an increase in interhospital transfers from less resourced ICUs to the referral center, a trend that is not readily explained by increased severity of illness.
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
2Mayo Clinic Health System-Reporting and Analytics Team, LaCrosse, WI.
3Division of Biostatistics, Mayo Clinic, Rochester, MN.
4Division of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN.
*See also p. 1417.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Dr. Pannu received funding from National Center for Advancing Translational Sciences, and received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: caples.sean@mayo.edu
