title: Telemedicine coverage for post-operative ICU patients.
abstract: Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service 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.
authors.affiliation: 1 Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Tara Ann
authors.initials: TA
authors.lastname: Collins
authors.affiliation: 2 University of Virginia, Charlottesville, Virginia.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Robertson
authors.affiliation: 1 Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Corinna P
authors.initials: CP
authors.lastname: Sicoutris
authors.affiliation: 1 Department of Advanced Practice, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pisa
authors.affiliation: 3 Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.affiliation: 3 Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.affiliation: 4 Department of Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kohl
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D055872:Surge Capacity; D017216:Telemedicine / Q000379:methods*
keywords: ICU surge capacity; advanced practitioners; nurse practitioner; post-anaesthesia care unit