Study Suggests Telemedicine ICU Coverage Lowers ICU Mortality but Not In-Hospital Mortality
Staffing of intensive care units with physicians specially trained to care for critically ill patients (intensivists) is associated with improved survival. Because many hospitals lack the patient volume or financial resources to hire dedicated intensivists – and because of a shortage of these trained specialists – hospitals are increasingly adopting telemedicine ICU (tele-ICU) coverage. Typically tele-ICU coverage uses a combination of videoconferencing technology, telemetry, and an electronic medical record to allow off-site intensivists and/or critical care nurses to assist in treating critically ill patients. This systematic review of the literature identified 13 controlled studies published between 1/1950 and 9/2010 that included 35 ICUs (from 27 non-VA hospitals) and more than 41,000 patients. Conducting a meta-analysis, investigators examined the impact of tele-ICU coverage on mortality and length of stay. Across studies included in this analysis, there was significant variation in how tele-ICU monitoring was used (e.g., round-the-clock vs. weekends and evenings), and the hospitals where it was evaluated (e.g., community hospitals vs. academic medical centers).
- Tele-ICU coverage was associated with a significant 20% reduction in ICU mortality, but did not significantly reduce in-hospital mortality for patients admitted to an ICU.
- Tele-ICU coverage was associated with a 1.26 day mean reduction in ICU length of stay, which translates into a 10%-30% relative reduction in ICU length of stay.
- Tele-ICU was not associated with a reduction in the patient’s length of stay in the hospital.
- There was significant variation among studies in the effects of tele-ICU and in how outcomes were reported and analyzed.
- Cost data were seldom reported; therefore, investigators were unable to draw meaningful conclusions regarding the cost or cost-effectiveness of tele-ICU.
- Possible reasons that tele-ICU significantly reduced ICU-specific mortality but not in-hospital mortality include: 1) fewer studies reported in-hospital mortality, thus the analysis may not have been large enough to detect a true effect or 2) implementation of tele-ICU might cause more patients with a good prognosis to be cared for in the ICU.
This study was partly funded through HSR&D. Drs. Young and Cram are part of HSR&D’s Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City, IA.
Young L, Chan P, Lu X, Nallamothu B, Sasson C, and Cram P. Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes: A Systematic Review and Meta-Analysis. Archives of Internal Medicine March 28, 2011;171(6):498-506.