title: Projecting Critical Care Beyond the ICU: An Analysis of Tele-ICU Support for Rapid Response Teams.
abstract: The rapid response team (RRT) concept was developed to improve care for decompensating patients outside of the intensive care unit (ICU) setting. The tele-ICU service (eICU(®)) at Health First Hospitals (Brevard County, FL) has provided tele-critical care support for patients outside the ICU using a mobile platform (the eMobile platform) since 2012. In this study we sought to evaluate the ability of eMobile to support care administered by RRTs.
  
  
  
  A retrospective review evaluating mobile cart activations for RRT calls was performed. Data on mobile cart deployments were recorded over a 33-month period from January 2012 through September 2014.
  
  
  
  Five hundred eighty mobile cart activations for critical care support were initiated by RRTs, and 577 were completed (>99%). For recorded gender, 223 patients (47%) were male, and 248 (53%) patients were female. Mean recorded age was 70 ± 16 years (median, 72 years). The most common patient conditions were respiratory distress (n = 190, 33%), altered mental status (n = 137, 24%) and hypotension (n = 59, 10%). The most common interventions were medication orders (n = 231, 40%) and laboratory studies (n = 92, 29%). For 566 eMobile calls with documented dispositions, 189 patients (33%) were managed without ICU upgrade. No adverse patient outcomes were recorded involving eMobile. Compared with the RRT program in 2009, the last year before testing of eMobile began (2010-2011), addition of tele-critical care support for calendar years 2012 and 2013 increased projected cost avoidance from unnecessary ICU transfers by a mean of 66% above the 2009 baseline. For Fiscal Year 2014, a projected cost avoidance analysis for unnecessary ICU transfers including costs of information technology (IT) support demonstrated a return on investment up to $1.66 for every $1 invested in IT support.
  
  
  
  Mobile critical care coupled with RRT is clinically effective and can generate meaningful cost avoidance.
authors.affiliation: 1 Trauma, Acute Care Surgery, and Critical Care, Health First Holmes Regional Medical Center , Melbourne, Florida.|2 Department of Surgery, Health First Holmes Regional Medical Center, University of Central Florida College of Medicine , Orlando, Florida.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pappas
authors.affiliation: 3 Health First Tele-Health , Rockledge, Florida.
authors.forename: Luann
authors.initials: L
authors.lastname: Tirelli
authors.affiliation: 3 Health First Tele-Health , Rockledge, Florida.
authors.forename: James
authors.initials: J
authors.lastname: Shaffer
authors.affiliation: 3 Health First Tele-Health , Rockledge, Florida.
authors.forename: Scott
authors.initials: S
authors.lastname: Gettings
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D005260:Female; D057209:Hospital Rapid Response Team / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration* / Q000592:standards
keywords: e-health; mobile health; telehealth; telemedicine