(Ivanhoe Newswire) – When intensive care physicians (intensivists) care
for ICU patients onsite, there is a lower rate of illness and death. There is an
acute shortage of intensivists, however, which has led to the increased use of
telemedicine to remotely monitor ICU patients.
Eric J. Thomas, M.D., M.P.H., of the University of Texas Health Science Center
at Houston, and colleagues assessed the effect of a tele-ICU intervention on
mortality, complications, and length of stay in six ICUs by measuring these
outcomes before and after implementation of the tele-ICU. The study included
approximately 2,000 patients in both the pre-intervention period from January
2003 to August 2005, and in the post-intervention period from July 2004 to July
2006.
"[The] . . . shortage of intensivists has led to the use of telemedicine
technology to allow intensivists to remotely and simultaneously care for
patients in several ICUs . . . thus extending their reach," the authors were
quoted as saying. "Remote monitoring may be a partial solution for the
intensivist shortage, but it is expensive, its use is increasing, and there are
few data in the peer-reviewed literature evaluating its effect on morbidity and
mortality."
The tele-ICU system included a remote office equipped with audiovisual
monitoring and a computer workstation providing real-time vital signs with
graphic trends, audiovisual connections to patients' rooms, early warning
signals regarding abnormalities in a patient's status, and access to imaging
studies and the medication administration record. Tele-ICU physicians conducted
rounds based on subjective assessments of illness severity.
After adjustment for severity of illness, there were no significant differences
associated with the telemedicine intervention for hospital mortality. The
observed average hospital length of stay among patients who survived to
discharge was 9.8 days pre-intervention and 10.7 days post-intervention.
"There was a significant interaction between the tele-ICU intervention and
severity of illness, in which tele-ICU was associated with improved survival in
sicker patients but with no improvement or worse outcomes in less sick
patients," the researchers wrote.
"Given the expense of tele-ICU technology, the conflicting evidence about its
effectiveness, and the existence of other effective quality improvement
interventions for ICUs, further use of this technology should proceed in the
context of careful monitoring of patient outcomes and costs."
SOURCE: Journal of the American Medical Association (JAMA), December 23/30, 2009
