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Early Impact Of Tele-ICU Implementation On Patient Mortality And Length-Of-Stay: An Analysis From The VA Healthcare System
Nassar B, Jiang L, Reisinger HS, Conello R, Cram PM. Early Impact Of Tele-ICU Implementation On Patient Mortality And Length-Of-Stay: An Analysis From The VA Healthcare System. Poster session presented at: American Thoracic Society Annual International Conference; 2013 May 20; Philadelphia, PA.
There is abundant evidence that dedicated intensivist staffing improves outcomes in the intensive care unit (ICU). As a result of this evidence, there is a nascent movement towards all ICUs having 24-7 intensivist coverage. However, a limited supply of intensivists or an insufficient patient volume makes it impossible for many hospitals to hire and retain intensivists. Tele-ICU allows physicians located in a monitoring center to manage and treat patients located at geographically distant ICUs. Despite great hope about the potential impact of Tele-ICU on patient outcomes, existing data evaluating its impact of this technology is mixed. Our objective is to examine the impact of introducing Tele ICU into seven hospitals in the Veterans Administration Healthcare System (VA) as part of a large prospective evaluation of Tele-ICU.
We conducted a time-series analysis by identifying patients hospitalized in 8 ICU's located within 7 hospitals in the Midwest during 2011-2012. Our intervention group consisted of patients admitted to ICUs where Telemedicine will be implemented. Our control group consisted of matched ICU's without remote monitoring. We looked at outcomes 6 months before, and 6 months after the introduction of Tele-ICU. We compared patient demographics and outcomes such as ICU, hospital and 30 day mortality; ICU and hospital LOS in all 4 groups (intervention group, control group, 6 months pre and 6 months post implementation). We looked at unadjusted outcomes and adjusted outcomes using abnormal lab values and comorbidities.
The mean age of ICU patients, patient demographics and comorbidities were similar between the intervention and control groups. In the evaluation of unadjusted and adjusted outcomes, there was no difference in ICU, hospital or 30 day mortality in the intervention group after the start of TICU (Unadjusted outcomes: ICU mortality 2.9 2.8%, hospital mortality 3.6 4.3%, 30 day mortality 7.7 7.8%). Similarly, ICU and hospital length of stay were not statistically different before and after the introduction of TICU (ICU LOS 2.9 2.9 days; hospital LOS 6.8 6.5 days).
In an analysis of a Tele-ICU implementation in a network of 8 ICU's within 7 VA hospitals in the Midwest we found little evidence of impact on mortality or LOS 6 months after the launch of the program. Additional analyses including other outcomes and looking at longer-term changes are currently underway.