No additional benefit seen with remote offsite monitoring of ICU patients
Research Activities, July 2010, No. 359
Ideally, hospital intensive care units (ICUs) should have 24/7 coverage provided by specialists called intensivists. However, a shortage of these physicians is making it difficult for hospitals to manage their ICUs effectively. As a result, hospitals are resorting to the use of telemedicine. With this approach, intensivists can manage the care of patients in several ICUs at the same time from a remote location. Yet, these tele-ICUs are not associated with a reduction in overall hospital mortality for patients, concludes a new study.
Researchers studied the impact of tele-ICU patient management in six ICUs located in five hospitals that were part of a large health care system. They collected data on 2,034 patients who received traditional ICU care prior to the implementation of the tele-ICU monitoring system and 2,108 patients studied after the system was in place and being used. Hospital mortality rates were 12 percent during the preintervention and 9.9 percent during the postintervention period. However, after researchers adjusted for the patients' severity of illness, no significant differences in hospital mortality were associated with the tele-ICU intervention. There was an improved survival rate in sicker patients cared for under the tele-ICU intervention, but no improvement or worse outcomes in less sick patients. Hospital or ICU length of stays did not significantly change between the pre- and post-intervention periods.
The researchers suggest the findings may be attributable to low decisional authority granted to the tele-ICU as well as to varied effects across different types of patients. Since tele-ICU interventions require substantial resource and infrastructure investment, more research is needed on the potential outcomes and costs associated with this new approach to caring for critically ill patients, conclude the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS15234).
See "Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay," by Eric J. Thomas, M.D., M.P.H., Joseph F. Lucke, Ph.D., Laura Wueste, R.N., and others in the December 23, 2009, Journal of the American Medical Association 302(24), pp. 2671-2678.