Virtual Critical Care for Eastern Ontario-A Cost-Benefit Analysis.

Abstract

Background: Virtual critical care (VCC) programs provide remote specialist support to community hospitals caring for critically ill patients, yet Canadian evidence regarding their economic impact remains limited. This study aimed to estimate the cost savings associated with a newly implemented VCC program in Eastern Ontario.

Methods: A retrospective cost-benefit analysis of the first 19 months of a regional VCC program based at a tertiary academic center supporting 13 community hospitals was conducted. All adult patients with an initiated VCC consultation were included. Cost estimates focused on avoided interfacility transfers, transportation costs, and differences in inpatient costs between academic and community hospital settings. Descriptive statistics were used to compare estimated cost savings with program operating costs.

Results: Between April 2023 and October 2024, 473 VCC calls representing 312 unique patient encounters were recorded (298 patients included in analysis). Transfers to larger centers were avoided in 179 cases (60%). Avoided land ambulance transfers were estimated to save $61,101 CAD over the study period. Estimated inpatient cost savings associated with avoided transfers ranged from $687,643 CAD (mean length of stay [LOS]) to $2,681,420 CAD (median LOS), corresponding to monthly savings of $36,191-$141,127 CAD. These savings approached or exceeded the estimated VCC program monthly operating cost.

Conclusion: The Eastern Ontario VCC program was associated with substantial estimated cost savings, primarily through avoided transfers and reduced use of high-cost academic intensive care beds. These findings support VCC as a potentially cost-effective health system intervention for supporting critically ill patients in community hospitals.