SAN DIEGO — Most research suggests that hospitals with intensivists, board-certified physician who provides specialized care for critically ill patients save more lives.
In the U.S. military, however, many smaller hospitals don’t employee them. A recent study published in Military Medicine focused on a MTF in that situation, Naval Hospital Camp Pendleton (NHCP), which operates a six-bed Intensive Care Unit (ICU) north of its referral center, Naval Medical Center San Diego (NMCSD).1
Researchers from NMCSD looked at what happened when, to remedy the gap in NHCP on-site intensivist coverage, a comprehensive tele-critical care (TCC) support system was established between the two facilities. To do that, they compared NHCP surgical ICU admissions before and after tele-critical care implementation.
Under the program, remote intensivists care for patients by utilizing video teleconferencing technology and remote access to electronic medical records. Study authors noted that standardization was achieved by adopting protocols and mandatory intensivist involvement in all ICU admissions. Of 828 ICU admissions, 21% were surgical and, therefore, part of the review.
Results indicated that TCC provided coverage during 35% of the intervention period. Comparing pre-TCC and post-TCC periods, the researchers documented a significant increase in the percentage of surgical ICU admissions [15.3 % vs 24.6%, p = 0.01] and the average monthly APACHE II score [4.1vs 6.5, p = 0.03]. The total number of surgical admissions per month also increased [3.9 vs 6.3, p = 0.009]. No adverse outcomes were identified.
“Implementation of TCC was associated with an increase in the scope and complexity of surgical admissions with no adverse outcomes,” the researchers concluded. “Surgeons were able to safely expand the surgical services offered requiring perioperative ICU care to patients who previously may have been transferred.”
The researchers also described the benefits of such a program, explaining, “Caring for these types of patients not only maintains the operational readiness of deployable caregivers but patient experience is also enhanced by minimizing transfers away from family. Further exploration of TCC on surgical case volume and complexity is warranted.”
1Van Gent JM, Davis KL, Henry N, Zander AL, Kuettel MA, Edson T, Nelson TJ, Tadlock MD. The Initial Impact of Tele-Critical Care on the Surgical Services of a Community Military Hospital. Mil Med. 2018 Apr 4. doi: 10.1093/milmed/usy051. [Epub ahead of print] PubMed PMID: 29635539.