254: TELEMEDICINE CRITICAL CARE AVAILABILITY AND OUTCOMES AMONG MECHANICALLY VENTILATED PATIENTS

Abstract

Introduction: Mechanical ventilation (MV) interventions like low tidal volume ventilation and daily spontaneous awakening and breathing trials are associated with improved survival but are unevenly implemented in real-world practice. Telemedicine Critical Care (TCC) improves adherence to these interventions. Whether or not hospitals with TCC have better MV outcomes than hospitals without TCC is unknown. We evaluated the association of hospital availability of TCC and outcomes among MV patients. Methods: We analyzed 19,679 adult non-surgical, mechanically ventilated patients in an Intensive Care Unit (ICU) in 2018 at 310 non-federal State Inpatient Database hospitals in Florida, Massachusetts, Maryland, and New York. The primary predictor variable was availability of TCC at a study hospital. The primary outcome was mortality defined as hospital death or discharge to hospice. Secondary outcomes were a composite of tracheostomy or re-intubation and duration of mechanical ventilation. We used a two-level hierarchical multivariable logistic regression model to investigate whether TCC availability was associated with study outcomes. Results: Among 19,679 mechanically ventilated patients, 6,177 (31.4%) occurred in TCC hospitals. Compared to non-TCC hospitals, TCC hospitals had reduced but insignificant odds of mortality (odds ratio [OR] 0.97, 95% CI 0.85–1.09), composite of tracheostomy/re-intubation (OR 0.93 [0.78–1.0]), and duration of mechanical ventilation (OR 0.95 [0.85-1.07]). Hospital size and annual mechanical ventilation case volume did not modify the association between TCC availability and mortality (P=0.75 and P=0.44 for interactions, respectively). Conclusions: Hospital availability of TCC was not associated with lower odds of mortality among mechanically ventilated patients.