1. Innovative Solutions to the Physician Shortage with Telemedicine Focus: Intensive Care Unit Authors: Corey Scurlock, MD, MBA; Mary Jo Gorman, MD, MBA; Isabelle Kopec, MD, FACP, FCCP Background: While intensivist driven patient care is accepted as a recommended quality standard, because of the intensivist shortage even large hospitals are challenged to comply with these recommendations. In fact, less than 4% meet the Leapfrog Group standards. 1 It has been reported that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being and patient care. 2 For the purposes of this analysis, we used a study on the intensivist-to-bed ratio and assumed a ratio of 1 intensivist per 10 ICU patients during the day and 1 intensivist per 20 ICU patients at night. 3 Therefore, staffing a 20 bed ICU 24 hours per day requires approximately 6 intensivist FTEs. It is well recognized that given the 30,000+ shortage of intensivists in the USA, there must be alternative solutions to the manpower shortage. We report on the positive impact a tele-intensivist program can make on the local intensivist workforce need. Program description: Each facility has installed an outsourced tele-intensivist program provided by Advanced ICU Care. The program includes 24/7 intensivist presence in conjunction with advanced practice providers and CCRNs. Included in the program is technology licensed from Philips VISICU and a proprietary process ICU PERFORMANCE SOLUTION™ which includes analytics and program design. Each facility committed to some bedside intensivist care. Methods: We examined the impact of a 24-7 tele-intensivist program on the labor needs at non-tertiary hospitals. All facilities have had a tele-intensivist program for greater than one year. The intensivists at the bedside conduct daily multi-disciplinary rounds and perform procedures and consults. All facilities identified medical staff to be available after hours to return to the ICU at the request of the tele-intensivist. All programs have been maintained for a minimum of two years. The time frame surveyed was January 2005 to December 2012. Results: Over a multi-year period it has been demonstrated that the presence of a tele-intensivist program can significantly reduce the intensivist labor need in an ICU in the non-tertiary setting. 1.Angus DC, Shorr AF, White A, et al. Critical Care Delivery in the US. Crit Care Med 2006; 34:1016-1024 2.Ward NS, Ajessa B, Kleinpell R,et al. Intensivist/Patient Ratios in a Closed ICU: A statement from the SCCM Taskforce on ICU staffing 3.Dara SI, Afessa B. Intensivist-to-bed ratio: associations with outcomes in the medical ICU. Chest 2005; 128:567-572 www.icumedicine.com Hospital OneHospital TwoHospital Three ICU Beds122426 Most Recent Annualized Patient Volume45610042440 Predicted Intensivist FTEs466 Actual intensivists FTEs21.253 Length of program6 years3.5 years2.5 years Intensivist ScheduleDedicated to ICU Mon-Fri, 8 am to 5 pm. Rotates weekends with anesthesia group Dedicated to ICU 7days a week, 8 am to 5 pm. Rotates weekends with local pulmonary group Rotate 7 days on, 7 days as back up and 7 days off. 7A to 7P, approximately 14 shifts per month per physician