Association of Unit-Level Telecritical Care Intensity of Service and Length of Stay in the Intensive Care Unit.

Abstract

Background:Telecritical care (TCC) has been shown to improve outcomes in the intensive care unit (ICU). A TCC was developed and implemented a nocturnal TCC across 10 ICUs in our Health System. TCC coverage patterns and level of involvement vary among ICUs. We identified an opportunity to determine the impact of TCC involvement on the ICU length of stay (LOS).Objective:The primary objective of this study was to assess if intensity of service provided by TCC impacts ICU LOS.Methods:This retrospective review was conducted for all patients admitted to covered ICUs during a 2-year period. ICUs were stratified by the coverage model provided by the TCC and the count of orders placed by the TCC served as a surrogate for intensity of service. Confounding variables were abstracted from the Acute Physiology and Chronic Health Evaluation (APACHE) databases. Spearman's rank correlation coefficient was used to measure the strength of the relationship between ICU LOS and TCC order volume. A linear regression model was used to describe the relationship between order volume and ICU LOS, while adjusting for confounding variables.Results:There is a strong negative relationship between TCC order volume and ICU LOS, as shown by the Spearman rank correlation coefficient of -0.818. The associated p-value of 0.0038 supports the strength of this relationship.Conclusion:Our results demonstrate the impact of nocturnal TCC involvement in patient care. As TCC order volume per ICU admission increases, ICU LOS decreases. We interpret this as an indication for deeper involvement between the TCC team and any on-site providers.