Implementation and Evaluation of a 24/7 eICU (Enhanced ICU) Model of Care in Regional and Rural NSW ICUs

Abstract

Abstract Background The global COVID 19 pandemic was associated with an increased demand for respiratory support in Intensive Care Units (ICU) and measures were put in place in all jurisdictions to enhance ICU bed capacity. In NSW, a need was identified to enhance the capacity of rural and regional ICUs to manage large numbers of COVID19 patients if needed. Methods We implemented a virtual care enhanced Intensive Care Model to support 2 regional Intensive Care Units from our level 5 Intensive Care unit in June 2020. This consisted of daily review of all patients in these ICUs and availability of senior staff from the level 5 ICU for advice when needed. After the delta wave of COVID 19, we further enhanced this model to a 24/7 eICU model of care with round the clock eICU nurses. New cart computers with video and audio capacity were introduced and videoconferencing was conducted using NSW Health provided Pexip Infinity Connect. We evaluated our 24/7 eICU model of care using the quadruple aims of value-based care in NSW as well as for scalability and sustainability. Results Our evaluation revealed that this model of care is safe and effective, efficient with cost saving and is associated with positive clinician and patient experiences. We tested our model for scalability by supporting a third regional ICU and measured sustainability by continuing to support our two original regional ICUs throughout 2022 and to date in 2023. Our patients benefited from care closer to home and our model of care freed up ICU capacity at higher level ICUs to care for COVID19 patients and retrieval capacity for transfer of other critically ill patients In addition, there were associated health economic benefit related to decreased ICU admissions and decreased transfers out. Of note there were approximately 50% fewer transfers out associated with our study and an incremental cost effectiveness ratio of 0.14 indicating that every 14 cents spent was associated with 1 dollar saving. Conclusions We recommend that our eICU model of care is considered for Implementation in rural and regional ICUs or close observation units where care is provided by staff not specifically trained in Intensive Care. A single centralised collaborative eICU centre can support three to five centres if adequately resourced with technology, training and education and skilled staff.