Prolonged Tele-Critical Care Utilization Is Associated With Improved ICU Outcomes: Evidence From Veterans Affairs Hospitals

Objectives: To determine the impact of critical care telemedicine (tele-critical care [TCC]) implementation duration on clinical outcomes: ICU mortality, ICU length of stay (LOS), and mechanical ventilation utilization. Design: Retrospective cohort study. Setting: Thirty-five U.S. Department of Veterans Affairs (VA) hospitals (444 ICU beds) that used TCC between 2012 and 2020. Patients: One hundred ninety-three thousand three hundred sixty-seven patient stays meeting specific inclusion criteria from 2012 to 2020 were included in the study. Interventions: Critical care telemedicine (TCC) implementation. Measurements and Main Results: The standardized ICU mortality rate was calculated by comparing patient outcomes to expected outcomes, utilizing critical care prediction models. ICU LOS was standardized for illness severity and case mix. The rate of invasive mechanical ventilation was analyzed, comparing ventilator days against predicted values. Longer TCC utilization was linked with a trend toward lower standardized ICU mortality rates, with statistically significant reductions after a 5-year period. ICU LOS also showed a significant decrease with prolonged TCC deployment. While the rate of invasive mechanical ventilation declined over time, it was not significantly related to the TCC deployment duration. Conclusions: Extended TCC implementation improves ICU mortality rates and reduces ICU LOS. Longer TCC deployment has clear benefits on patient outcomes in the VA healthcare system. Further research should explore long-term effects and factors influencing TCC adoption.