Evaluation of Change in Medication Regimen Complexity-ICU (MRC-ICU) Score Following Implementation of a Virtual Intensive Care Model in a Multisite,Rural Health-System

Abstract

Background: Telehealth in the ICU (Tele-ICU) may improve patient outcomes and optimize utilization of high acuity intensive care unit (ICU) beds. However, the relationship between tele-ICU and medication regimen complexity-ICU (MRC-ICU) score is unexplored. Objective: To assess the effect of tele-ICU on MRC-ICU score and describe pharmacists’ work. Methods: Adult ICU encounters lasting at least 24 h were retrospectively compared pre- and post- implementation of tele-ICU services in a rural, five-hospital system. The primary outcome was MRC-ICU score 24 h after ICU admission. Prospectively, pharmacist interventions during ICU encounters were captured. Encounters were categorized on exposure to clinical pharmacist review. Results: The difference in mean MRC-ICU score between pre- and post-intervention encounters was −0.2032 (95% CI,-0.8253, 0.4188, P = 0.5217). Post-intervention encounters had a higher rate of thromboembolism prophylaxis (64.5% vs 54.9%, P = 0.001), higher adherence to stress-ulcer prophylaxis (74.1% vs 60.9%, P < 0.001), and a lower presence of glycemic control agent(s) (39.8% vs 46.2%, P = 0.017) 24 h after ICU admission. Tele-ICU services did not significantly change ICU LOS (3.261 vs 3.166 days, P = 0.536), nor ICU mortality (11.1% vs 12.7%, P = 0.377). In the prospective period (n = 196 encounters), 189 interventions were recorded on 80 encounters. There was no difference in median MRC-ICU score at 24 h in encounters with clinical pharmacist review and intervention vs without scheduled clinical pharmacist review (9 vs 8, P = 0.0596). Conclusion: Implementation of Tele-ICU did not change the MRC-ICU score at 24 h, although some ICU bundled care metrics improved. Many encounters lack opportunity for meaningful pharmacy interventions.