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Impact of Tele-ICU Coverage on Patient Outcomes: A Systematic Review and Meta-Analysis
Young LB, Chen P, Lu X, Nallamothu B, Sasson C, Cram PM. Impact of Tele-ICU Coverage on Patient Outcomes: A Systematic Review and Meta-Analysis. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
Objectives: A shortage of intensivists has prompted technological innovations to enhance the quality of care in intensive care units (ICUs). Tele-ICU is one way to extend intensivist coverage to ICU shifts and locations where it was previously unavailable, for example, in rural areas. Although healthcare organizations are rapidly adopting expensive tele-ICU systems, their impact on patient outcomes is unclear. We conducted a meta-analysis to examine the impact of tele-ICU coverage on mortality and length-of-stay (LOS).
Methods: We conducted a systematic review of studies published through June 30, 2010, using PubMed, CINAHL, Global Health, Web of Science, and the Cochrane Library, as well as conference abstracts. Prospective studies of tele-ICUs that reported data on the primary outcomes of ICU and hospital mortality or on the secondary outcomes of ICU and hospital LOS were included. Data abstraction focused on ICU structure and staffing, tele-ICU equipment and operation, and clinical outcomes.
Results: A total of 13 studies involving 41,577 ICU patients met the inclusion criteria. Tele-ICU coverage was associated with a significant reduction in ICU mortality (pooled OR, 0.80; 95% CI, 0.66 to 0.97; p = 0.025), but was not associated with a significant reduction in hospital mortality for patients admitted to an ICU (pooled OR, 0.82; 95% CI, 0.65 to 1.03; p = 0.08). Similarly, while tele-ICU coverage was associated with shorter ICU LOS (mean difference, -1.26 days; 95% CI, -2.21 to -0.28; p = 0.01), it did not result in significantly shorter hospital LOS for patients admitted to an ICU (mean difference, -0.64; 95% CI, -1.52 to 0.25; p = 0.16). Wide variation was noted in study quality, ICU characteristics, and tele-ICU configurations.
Implications: Tele-ICU coverage was associated with lower ICU mortality and LOS, but was not associated with lower hospital mortality or LOS. Additional research should clarify whether tele-ICU benefits are confined to the ICU or also enhance patient survival after ICU discharge. Future research additionally should clarify the influence of ICU characteristics and tele-ICU configurations, alone and in combination, on the effectiveness of tele-ICU.
Impacts: In evaluating tele-ICU effectiveness, hospitals should monitor clinical outcomes and cost data both within and outside the ICU.