(342) Implementation of Virtual Surgical Critical Care Results in Cost Savings: A Conservative Projection

Introduction: Management of critically ill surgical patients (CISP) is typically offered by medical providers. Surgical Intensivists (SI) have a perioperative pattern recognition which may facilitate rapid resuscitation and ICU liberation. We have demonstrated opportunity days gained by embedding a virtual SI (VSI), utilizing our Tele-Critical Care platform, into the care of CISP without access to bedside SI. In this study we aim to project cost savings based on estimated opportunity days identified after VSI consultation.

Methods: VSI evaluated CISP at 9 hospital ICUs in our healthcare system, provided consultation, and communicated with bedside teams. The VSI recorded assessment of care prior to consultation as Optimal Practice (Opt), Generally Accepted Practice Standards (GAPS) met with Opportunity for Improvement (OFI), or GAPS not met (GAPSnm). Reasons for non-optimal care and frequency of recommendation acceptance were recorded in a REDCap database. Reasons for non-optimal care were converted to measurements of opportunity days (Ventilator, ICU or hospital days) based on an assessment definition of 2 days for GAPSnm and 1 day for OFI. Cost analysis of total opportunity was then performed using average expenditures for ventilator ($1,522), ICU ($3,184), and hospital ($1,909) days from available literature.

Results: Nine months after implementation of VSI consultation, 947 patients were reviewed. The 3 most frequent opportunities identified were prolonged ventilation (6 GAPSnm, 25 OFI), delayed resuscitation (25 GAPSnm, 50 OFI) and delayed nutrition (7 GAPSnm, 37 OFI). Assuming 50% of recommendations were accepted by bedside teams, annualized opportunities were 24.7 ventilator days, 66.7 ICU and 34 hospital days. Using conservative cost estimates, these are system cost reductions of $37,590, $212,370, and $64,900 respectively.

Conclusions: Using a conservative approach to identify opportunity days and cost reductions, we project the incorporation of VSI consultation in resource limited environments could provide cost savings to the healthcare system.