Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period ( ) and during the Tele-ICU period ( ) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and health evaluation (APACHE IV) scores. Mean APS scores were 37.1 (SD, 22.8) and 37.7 (SD, 19.4) ( ), and mean APACHE IV scores were 49.7 (SD, 24.8) and 50.4 (SD, 21.0) ( ), respectively. ICU mortality was 7.9% during the preintervention period compared with 3.8% during the Tele-ICU period (odds ratio (OR) = 0.46, 95% confidence interval (CI), 0.32–0.66, ). ICU LOS in days was 2.7 (SD, 4.1) compared with 2.2 (SD, 3.4), respectively (hazard ratio (HR) = 1.16, 95% CI, 1.00–1.40, ). Implementation of Tele-ICU intervention was associated with reduced ICU mortality and ICU LOS. This suggests that there are benefits of a closed Tele-ICU intervention beyond what is provided by daytime bedside physicians. 1. Introduction More than 5.7 million adults are admitted yearly to intensive care units (ICUs) in the United States [1]. Hospital costs for critically ill patients admitted to the ICU are more than $67 billion annually [1]. Mortality rates for these patients average 10–15%, which is equivalent to approximately 540,000 deaths each year [2]. Evidence shows superior clinical outcomes with a dedicated intensivist staffing model [3]; however, 85–90% of US hospitals do not use this model [4]. The Leap Frog Model was created as an effort to reduce preventable medical mistakes. The model recommends that large employers provide more market reinforcement for the quality and safety of health care. The founders realized that they could take “leaps” forward with their employees, retirees, and families by rewarding hospitals that implement significant improvements in quality and safety. The Leapfrog group has provided guidelines for ICUs, which recommend intensivist-led care for all patients in ICUs, recognizing the opportunity to reduce in-hospital mortality. The Leapfrog model suggests that over 53,000 deaths that occur in the ICU could be avoided if the intensivists staffed all urban hospitals’ ICUs nationwide [5]. However, currently there is a shortage of bedside intensivists. In addition, with the aging population, it is projected that the need for intensivists will
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