Telemedicine Critical Care in Rural Hospitals During the COVID-19 Pandemic

Abstract

RATIONALE: The COVID-19 pandemic has caused urban and suburban hospitals to exceed their inpatient capacities, often requiring long periods of transfer diversion. This has had a dramatic impact on the rural hospitals of Georgia by forcing those facilities to care for critically ill patients that would have normally been transferred to referral hospitals for higher levels of care. Many rural facilities have the equipment to care for critically ill patients, but lack physicians trained and experienced in the management of critical illness. To mitigate this, Augusta University (AU) instituted a telemedicine program to provide critical care services to rural hospitals while keeping patients in their rural communities for optimal family and social support. METHODS: The telemedicine critical care program was started in three rural hospitals, but rapidly expanded to three more hospitals based on initial successes. These sites are staffed predominately by primary care physicians with no critical care trained physicians available. Telemedicine services were provided by AU Emergency Physicians with a Critical Care trained physician providing medical oversight. Telemedicine consults were initiated either in the ED or after the patient was admitted to the hospital. Evaluations were continued daily until the patient was discharged, transferred, or transitioned to comfort care. If a patient's care requirements exceeded the capability of a rural site despite critical care telemedicine involvement, AU accepted all transfers regardless of diversion status. RESULTS: From July 20, 2020 through December 20, 2020, 213 patients were evaluated and treated using the telemedicine program. The average length of consultation was 5.1 days. 70.0% of patients were discharged from the rural facilities and 10.3% were provided end-of-life care without transfer. Only 19.7% were transferred to the tertiary hospital. The transfer rate from the rural hospitals decreased by approximately 80% as compared to prior. Mortality and discharge outcomes amongst patients in the telemedicine program were no worse than those at the tertiary referral center. CONCLUSION: The telemedicine critical care program has been received enthusiastically by the participating rural hospitals, and additional sites are seeking to join. It has allowed these hospitals to safely care for substantially more complex patients while still guaranteeing expeditious transfer in the event local capability is exceeded. This approach provides for enhanced patient care and safety while keeping patients close to their families and communities. It has been instrumental in helping to resolve healthcare disparities between rural and suburban/urban Georgia during the COVID pandemic.