Background: Safety-net hospitals are disproportionately affected by the national intensivist shortage. The Society of Critical Care Medicine estimates the U.S. needs over 48,000 intensivists, but fewer than half are available. This shortage is pronounced in rural and underserved urban areas, leaving hospitalists in resource-limited settings to manage critically ill patients with minimal or no intensivist support. This leads to increased patient transfers, overburdened clinicians, and strain on hospitals, compromising patient care. We describe and report the implementation of a Tele-ICU program in medically underserved regions of Los Angeles and share real-world data, including preliminary findings on key patient outcomes.
Purpose: Pipeline Health comprises four Los Angeles safety-net hospitals without in-house intensivists. In September of 2024, we launched a remote intensivist program designed to connect these hospitals to high-quality virtual critical care 24/7. Our mission was to enhance efficiency, improve patient outcomes, and address critical care inequities.
Description: Our telemedicine critical care program is the largest, remote only intensivist program in Southern California. This model maximizes efficacy and provides exceptional patient care through low-cost and HIPAA-compliant innovations:1. AI remote transcription enables real-time, accurate physician note-taking, reducing documentation time by 2-3 hours and increasing face-to-face interactions. 2. Through a scalable spoke-and-hub model, a single, experienced intensivist can be on call and round at multiple hospitals regardless of their location. This approach fosters long-term relationships with on-site teams while providing increased support and expertise. 3. A low cost video conferencing platform allows providers to engage with patients and their loved ones, informing them of the treatment plan, and addressing any questions or concerns. It enhances multi-disciplinary rounding among members of a patient’s care team (e.g. nurses, RTs, social workers). 4. RT/RN protocols and a comprehensive nursing template standardizes care and optimizes rounding efficiency. These are adaptable to ICU patient’s needs, mimicking in-person workflows. 5. Tele-ICU addresses intensivist burnout by enabling experienced and well-trained intensivists to work remotely, providing them better work-life balance, and eliminating commute times.Our preliminary analysis two months post-implementation reveals that 448 unique patients were seen, accounting for 1,272 patient days. The average patient age was 63 year old, 59.8% males and 40.2% females. The most common diagnoses were Acute Respiratory Failure with Hypoxia (40.8%), Pneumonia (24.1%), Septic Shock (22.1%), and Chronic Obstructive Pulmonary Disease (5.1%). We also observed a reduction in ICU length of stay 3.44 days (2023) vs 3.02 days (2024).
Conclusions: Our program offers hospitalists 24/7 on-demand access to intensivists for fully remote management of critically ill patients, significantly reducing the need for patient transfers and enhancing their ability to care for the sickest patients. Standardized protocols, multi-disciplinary rounding, and AI-driven documentation allow our program to address critical care disparities in underserved hospitals. This innovation improves patient outcomes, strengthens hospital workflows, and supports hospitalists in delivering high-quality care and early data shows a reduction in ICU Length of Stay.