277: Outcome Improvement After Proactive Telecritical Care Model Implementation in a Rural Setting

Introduction: Telecritical Care has been used for several decades, with accelerated adoption both during and in the aftermath of the Covid-19 global pandemic. The literature surrounding telecritical care has been conflicting and inconclusive. This inconsistency is likely due to the wide variation in telecritical care delivery models, and the model matters. We aimed to demonstrate the impact of proactive telecritical care implementation, with mandatory telecritical care consultation, on crucial ICU outcome metrics. Methods: We implemented a proactive 24/7 telecritical care model in a rural ICU in the Midwest in December 2022. It is an open ICU staffing model with mandatory consultation of Board-certified telecritical care specialists to co-manage critically ill patients. The teleintensivists rounded on the patients daily, documented in the medical record, placed orders in the EHR, and participated in multidisciplinary rounds daily. In addition, SAT/SBT protocols were implemented in Spring 2024. We collected metric data between January 2023 and January 2025 through the computerized charting system, Meditech Expanse, collecting data on ICU length of stay, average duration of mechanical ventilation, and ICU readmission rates. We defined ICU readmission rate as the proportion of patients readmitted to the ICU after at least 24 hours of being discharged from the ICU. Results: Between January 2023 and January 2025, 537 patients were seen by telecritical care specialists. In the two years following implementation of our model, the average ICU length of stay decreased by 14% (2.2 to 1.9 days per patient); the average duration of mechanical ventilation decreased by 35% (2.87 days to 1.89 days per patient); and ICU readmission rates decreased by 43% (5.13% to 2.94%). Conclusions: These findings suggest that a proactive telecritical care model in an open ICU with mandatory specialist co-management can improve ICU efficiency and patient outcomes, including reduced ICU LOS, duration of mechanical ventilation, and ICU readmissions. This is hypothesis-generating and supports the notion that both the tele-ICU model and its implementation strategy may critically influence the effectiveness of remote critical care in achieving clinical benefits.