Attending, Critical Care Medicine Boston Children's Hospital
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Introduction: The COVID-19 pandemic led to a massive expansion of critical care capacity in India. A new challenge emerged as the acute crisis subsided: how to sustain and effectively utilize this expanded infrastructure beyond the pandemic. This AI augmented tele-ICU model offers a promising solution for a broad spectrum of non-COVID critical care needs, thereby driving long-term improvements in care delivery, enhancing access for underserved populations, and improving patient outcomes.
Methods: This retrospective cohort analysis examined ICU admissions from June 2020 to September 2024 in a network of tele-ICU-supported hospitals in India. Data were collected on daily admission volumes, primary ICD-10 diagnoses and demographics. Outcomes measured and tracked included compliance with Hand hygiene , Deep Vein thrombosis (DVT) prevention bundle and CLABSI prevention bundles. Mortality for patients on pressors and those invasively ventillated, and ventilator-free days (VFD). Regression models were used to quantify trends over time, with a focus on non-COVID admissions and trends in APACHE II scores.
Results: Analysis of 52 months of data across 217 healthcare units revealed a significant shift in ICU utilization. Non-COVID-19 admissions showed a highly significant upward trend, increasing by an average of 55 admissions per month (β=55.17,p < 0.001). Statistically significant monthly increases were found for sepsis, acute coronary syndromes, and various neonatal conditions (all p< 0.001). Despite an increasing severity of illness (average APACHE II score increased by 0.09 points per month, β=0.094,p < 0.001), the tele-ICU model was associated with improved clinical and QI outcomes.There was a 22.57% net reduction in hospital mortality among pressor patients and a 27.75% mortality reduction in invasively ventillated patients. VFD also significantly increased by 0.088 days per month (p < 0.001).
Conclusions: The implementation of a technology-augmented tele-ICU model provided an effective strategy for repurposing critical care infrastructure originally established for the COVID-19 pandemic. The sustained improvements in clinical metrics, including mortality and VFD, highlight the value of tele-ICU models as a sustainable solution for enhancing high-quality critical care services in resource-constrained settings.
