605

Abstract

Introduction: Remote monitoring of ICUs (tele-ICU) can improve mortality, ICU length of stay and costs. However, little is known about the implementation process, structure and cost of tele-ICU programs, with a recent study reporting estimated first year implementation and operational costs of $50-100,000 per monitored bed. Methods: The Fairview tele-ICU program provides remote critical care services to five Fairview hospitals in Minnesota with the tele-hub located at the University of Minnesota Medical Center (UMMC), a major teaching hospital. A 24/7 critical care nurse staffs the hub. Since the tele-ICU physician workload is low during the day, the daytime MICU and SICU attending at UMMC alternates weeks of coverage. At night, an intensivist, from the Surgery, Medicine, or Anesthesia Departments, provides tele-physician services while also serves as the in-house faculty intensivist for the MICU and SICU services and their residents. All remote ICUs allow "full treatment as necessary" by the tele-intensivist. All tele-RNs and MDs maintain active bedside ICU practices and the majority of the tele-intensivists also attend in 1 or 2 of the remote ICUs. We developed a tele-ICU module within the EPIC electronic medical record (Verona, WI) complemented by SpaceLabs monitors (Snoqualmie, WA) and used local vendors to install 2-way video equipment in each patient room. Results: In 2012, we monitored 54 ICU-beds remotely. The average daily census was 32.6 patients with 16,973 patient-days per year monitored. Another 17,433 patient-days (average daily census of 36.8 patients) were cared for by the same team directly in the ICUs at UMMC. The initial capital cost of the tele-ICU was $1,186,220. The annual operational cost is $2,495,345, 99% of which is physician, nurse and administrative salary and benefits. There are no commercial licensing fees. 66% of the cost is paid by UMMC (because of the physician services providing overnight in-house coverage, defrayed by billable services) which decreases first year implementation and operational costs to $47,893 per bed, and annual operating cost to the remote sites of $25,926 per bed. Conclusions: A modest-sized tele-ICU system can be built and staffed for substantially less cost than previously reported. We achieved this by using a single EMR with "off the shelf" technology, avoiding licensing fees and subsidizing the intensivists' cost by combining face-to-face, billable care at UMMC with tele-ICU responsibilities.