VA telemedicine program reduces inter-hospital ICU transfers
The Department of Veterans Affairs’ Tele-ICU program, which provides remote access to comprehensive acute care, is helping to reduce inter-hospital transfers of critically ill patients to other facilities by leveraging telemedicine.
Small, community and regional ICUs in the VA’s health system often lack intensivists to provide advanced critical care. That’s where telemedicine serves to fill the gap, enabling staff to treat patients on site rather than transferring them to other hospitals.
According to Spyridon Fortis, MD, clinical assistant professor of medicine at the University of Iowa Hospitals and Clinics, tele-intensivists collaborate with local staff to co-manage patient care at the bedside, avoiding the need to triage patients to facilities that have more advanced capabilities.
Fortis, who also works for the Iowa City VA Health Care System, led a study of more than of 550,000 admissions to the VA’s ICUs and found that inter-hospital transfers decreased by 1.47 percentage points (from 3.46 percent to 1.99 percent) in the facilities with Tele-ICU, but only 0.34 percentage points (from 2.03 percent to 1.68 percent) in facilities without the services—between pre- and post-implementation periods.
Results of the study, published in the journal CHEST, also showed that the Tele-ICU did not change overall adjusted or unadjusted 30-day mortality.
“Our study validates that (the Tele-ICU) prevents transfers to other facilities without increasing the risk of mortality,” says Fortis, who notes that telemedicine was provided to 52 ICUs in 23 acute care facilities by two command centers located in Minneapolis and Cincinnati. “The on-site treatment helps to lower the cost of care and improves patient, family and staff satisfaction.”
The decrease in inter-hospital transfers was observed by investigators in all patient groups—including moderate, moderate-to-high, and high illness severity and in nonsurgical patients—with the exception of those presenting with mild illness severity.
“Patients don’t want to go to other facilities,” contends Fortis, who adds that the cost of transferring a patient is around $10,000 to move them from one hospital to another. “There are a lot of places now that are implementing Tele-ICUs across the country, not just the VA, and the number is increasing.”