Using telemedicine in ICUs (intensive care units) was found to improve patient outcomes – ICU mortality rates and length of hospital stays were reduced, researchers from the University of Massachusetts Medical School reported in JAMA (Journal of the American Medical Association).

Telemedicine in the ICU, known as Tele-ICU is the provision of care by doctors located far away from the ICU patients. The health care professional uses video, audio and electronic links to help whoever are caring for and monitoring critically ill patients.

The authors wrote as background information:

“Patient needs and societal costs of adult critical care have increased as predicted from population-based models, and more efficient methods of delivery of care are needed. A tele-intensive care unit is a promising technological approach designed to systematically alter processes of care that effect outcomes. Tele-ICU can be defined as the provision of care to critically ill patients by health care professionals located remotely.

Tele-ICU clinicians use audio, video, and electronic links to assist bedside caregivers in monitoring patients, to oversee best practice adherence, and to help create and execute care plans. Tele-ICU programs have the potential to target processes that are associated with better outcomes including shorter response times to alarms and abnormal laboratory values, more rapid initiation of life-saving therapies, and higher rates of adherence to critical care best practices.”

M. Lilly, M.D. and team set out to determine which tele-ICU processes were linked to better patient outcomes. They assessed the impact a tele-ICU intervention might have on the chances of dying in hospital, how long patients stayed in hospital, best practice adherence, and preventable complications.

The study involved 6,290 adult patients at 3 intensive care units – 3 surgical, 3 medical and 1 mixed cardiovascular – at an 834-bed academic medical center.

The remote tele-ICU team included an intensivist and used tele-ICU workstations.

The remote team had the following responsibilities:

  • Carrying out real-time audits of best practice adherence
  • Evaluating and reviewing the care of each patient
  • Intervening when bedside clinician responses were slow and patients appeared to be physiologically unstable
  • Monitoring electronic alerts
  • Reviewing bedside clinician responses to alarms

The remote team could record which tests, treatments, and consultations the clinicians had ordered. They could also monitor the management and use of life-support devices.

The researchers reported the following data gathered before and after tele-ICU intervention:

  • Hospital mortality rate during preintervention period – 13.6%
  • Hospital mortality rate during tele-ICU intervention – 11.8%
  • ICU mortality rate for preintervention group – 10.7%
  • ICU mortality rate for tele-ICU group – 8.6%
  • Length of hospital stay for preintervention group – 9.8 days
  • Length of ICU stay for preintervention group – 6.4 days
  • Length of ICU stay for tele-ICU group – 4.5 days
  • Best clinical practice adherence in the preintervention group – 85%
  • Best clinical practice adherence in the tele-ICU group – 99%
  • Prevention of stress ulcers in preintervention group – 83%
  • Prevention of stress ulcers in tele-ICU group – 96%

There were significant improvements in the tele-ICU group in prevention of ventilator-associated pneumonia and other preventable complications.

The fraction tele-ICU patients needing mechanical ventilation was considerable lower and the duration of mechanical ventilation significantly shorter than in the preintervention group, the authors added.

The tele-ICU patients had an 8% higher chance of going home, they had a significantly lower risk of having to go to rehabilitation or a long-term care facility.

The authors wrote:

“In conclusion, an adult tele-ICU intervention at an academic medical center that had been previously well staffed with a dedicated intensivist model and had robust best practice programs in place before the intervention was associated with lower mortality and shorter lengths of stay. Only part of these associations could be attributed to following best practice guidelines and lower rates of preventable complications. This suggests that there are benefits of a tele-ICU intervention beyond what is provided by daytime bedside intensivist staffing and traditional approaches to quality improvement . . .”

Jeremy M. Kahn, M.D., M.S., of the University of Pittsburgh, wrote:

“Telemedicine alone does not equate to quality improvement but is merely a tool for quality improvement. Accordingly, a successful telemedicine program will follow the basic tenets of quality improvement: performing a detailed needs assessment, assessing the barriers to practice change, prioritizing specific projects, introducing effective strategies for improvement, and measuring the results in a stepwise fashion.

Similar to traditional quality improvement, an approach in which this technology is introduced without setting specific quality goals and defining clear quality improvement processes is likely to fail. Instead, it is important to define specific quality deficiencies in the target ICUs, and then design the telemedicine intervention specifically to address those deficiencies, akin to other types of quality improvement.”

“Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes”
Craig M. Lilly, MD; Shawn Cody, MSN/MBA, RN; Huifang Zhao, PhD; Karen Landry; Stephen P. Baker, MScPH; John McIlwaine, DO; M. Willis Chandler, MBA; Richard S. Irwin
JAMA. Published online May 16, 2011. doi: 10.1001/jama.2011.697

Written by Christian Nordqvist