(1271) Outcomes and Satisfaction With ICU Staffing by Bedside APPs and Telemedicine Physician Supervision

Introduction: The aging population, rising patient complexity, and physician shortages are impacting access to critical care services at smaller hospitals. We propose an innovative ICU coverage model for a community hospital in a large academic network that combines the expertise of on-site Advanced Practice Providers (APPs) with the remote support from ICU Physicians. In May 2023, one community hospital in our network transitioned from 24-hour on-call ICU physician coverage to a 12-hour on-site coverage model led by an experienced critical care APP trained at the main academic facility, with telemedicine supervision during the day and exclusive telemedicine coverage at night. This strategic change aimed to maintain expertise in ICU coverage while optimizing resource allocation, making it a financially viable approach to care.

Methods: ICU quality metrics, including patient days, ventilator days, and ICU mortality index, were tracked monthly during the pre-intervention period (May 2022-April 2023) and post-intervention period (May 2023-April 2024) and compared using unpaired t-test. Satisfaction with the new staffing model was measured through a survey sent to nurses, providers, and administration in July 2024.

Results: From the pre-intervention to the post-intervention period, there were no statistically significant changes in average patient days per month (130.7±17.8 versus 125.4±14.0, p=0.42), ventilator days per month (19.0±10.3 versus 12.3±14.1, p=0.20), or ICU mortality index per month (0.79±0.69 versus 0.58±0.46, p=0.38). Most of the 17 respondents agreed or strongly agreed that communication with APPs was effective (17/17), communication with telemedicine physicians was effective (16/17), quality of APP care was adequate (16/17), and APPs responded promptly to requests (17/17). Most respondents to the survey believed the model was successful overall (16/17). Recommendations for improvement included expanding coverage to overnight hours.

Conclusions: The APP/Telemedicine model is a practical alternative for healthcare delivery without compromising patient care. The quality metrics measured, along with satisfaction surveys, support the continued use and potential expansion of this model to other community sites.