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Abstract

Introduction: To assess the value of adding a 131 bed 24/7 tele-ICU center to a bedside agitation program on ICU outcomes in a 22 bed academic MICU. Methods: System wide comprehensive revisions to pain, agitation and delirium (PAD) guidelines and order sets coupled with specific roles and responsibilities were developed and implemented. The tele-ICU identified ventilated pts receiving continuous infusion sedatives (SCI) with at least 3 consecutive RASS scores of 0 or lower, without a change in dose over the last 6 hours. On a regular basis, the bedside was contacted with the goal of decreasing the SCI by 10% every 6 hrs. The study consisted of 4 phases: Pre Program (1/11-8/11); Phase I – Program development, education and training (9/11-12/11); Phase II - ICU management only (1/12-10/12); Phase III - Tele-ICU and ICU collaboration (10/12-3/13). Data was collected to determine: demographics; ICU and hospital mortality; length of stay (LOS); ICU ventilator days; total PAD drug use (mg/pt). All data was APACHE IV adjusted and statistically analyzed via logistic regression or Cox proportional hazard models. Results: 2,249 pts were evaluated (Pre Phase:685; Phase I:318; Phase II:770; Phase III:476). Overall, 51.5% were male, mean (SD) age=62.0 (16.6) yrs; APACHE IV=82.0 (30.9). There were no statistical differences in: 1) demographics between phases; 2) any outcome from PRE to Phase I; 3) ICU mortality between phases. The only significant difference between PRE/Phase II was in ventilator days (4.9(5.0) vs 4.2(4.0) days, P< 0.01). Statistically significant findings occurred between Phase II/Phase III and PRE/Phase III (except as indicated) as follows (all results are PRE/Phase II/Phase III respectively): Hospital mortality-28.2%/23.6%/17.7% (P<0.001); ventilator days-4.3/3.5/3.2 (P<0.001 between PRE/Phase III only); ICU LOS-5.67/5.17/4.63 (P<0.05); Hospital LOS-15.7/15.9/14.0 (P<0.05 PRE/Phase III Only); Lorazepam use-7.2/0.1/0.0 (P=0.002 PRE/Phase II and PRE/Phase III Only); Propofol use-33.6/32.4/18.1 (P<0.001). Conclusions: Addition of tele-ICU collaboration with a bedside PAD program is effective and contributes to decreased LOS, mortality, ventilator days and medication use.