title: A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details.
abstract: BACKGROUND
  Improving the efficiency of critical care service is needed as the shortfall of intensivists is increasing. Standardizing clinical practice, telemedicine, and organizing critical care service at a health system level improves outcomes. We developed a health system Critical Care Program based at an academic medical center. The main feature of our program is an intensivist who shares on-site and telemedicine clinical responsibilities. Tele-ICU facilitates the standardization of high-quality critical care across the system. A common electronic medical record made the communications among the ICUs feasible. Combining faculty from medical and surgical critical care divisions increased the productivity of intensivists.
  
  
  METHODS
  We retrospectively reviewed the administrative database data from 2011 and 2012, including mean census, number of transfers, age, sex, case mix index, mortality, readmissions, and financial data.
  
  
  RESULTS
  The Critical Care program has 106 adult ICU beds; 54 of those beds can be managed remotely using tele-ICU based at the main University hospital. The mean midnight census of the system for 2012 was 69.44 and total patient-days were 34,406. The capital cost of the tele-ICU was $1,186,220. The annual operational cost is $1,250,112 or $23,150 per monitored ICU-bed. Unadjusted mortality was 6.5% before and 4.9% after implementation (p < 0.0002).
  
  
  CONCLUSIONS
  We describe a novel health system level ICU program built using "off the shelf" technology based on a large University medical center and a tele-ICU with a full degree of treatment authority across the system.
authors.affiliation: University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN; Critical Care and Acute Care Surgery Division, University of Minnesota, Minneapolis, MN; Pulmonary and Critical Care Division, University of Minnesota, Minneapolis, MN. Electronic address: forti042@umn.edu.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Fortis
authors.affiliation: University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN; Pulmonary and Critical Care Division, University of Minnesota, Minneapolis, MN.
authors.forename: Craig
authors.initials: C
authors.lastname: Weinert
authors.affiliation: University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN.
authors.forename: Robyn
authors.initials: R
authors.lastname: Bushinski
authors.affiliation: University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN.
authors.forename: Alison Greiner
authors.initials: AG
authors.lastname: Koehler
authors.affiliation: University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN; Critical Care and Acute Care Surgery Division, University of Minnesota, Minneapolis, MN.
authors.forename: Greg
authors.initials: G
authors.lastname: Beilman
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003422:Critical Care / Q000458:organization & administration*; D020000:Decision Support Systems, Clinical / Q000191:economics*; D005240:Feasibility Studies; D005260:Female; D017721:Hospital Costs / Q000458:organization & administration*; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D016730:Program Development; D011787:Quality of Health Care; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D014481:United States