Telehealth in the ICU

Like many health care innovations, telemedicine seems to expand slowly, perhaps more slowly than justified by its promise.  Telemedicine has a number of potential applications, often where scarce expertise can be brought to bear in areas with few health resources or at times when local resources are typically off or unavailable.  One example is the use of remote teams to monitor and guide the care of ICU patients, who are very complex and costly.  Research published in the Journal of the American Medical Association examines results from using such an approach in one academic medical center.   (JAMA Article)

The study compared pre-intervention with post-intervention results, using over 6000 patients.  The intervention was implementation of a remote ICU team which worked with on-site caregivers in the ICU and utilized guidelines for best care and made other process changes.  The off-site team was available 24 hours, did real-time audits of best practice adherence, and monitored responses to alarms and alerts.   Hospital mortality was the primary outcome, and ICU mortality, hospital and ICU length of stay, rates of adherence to best practices, and complication rates were also examined.

ICU and hospital mortality were lower following the intervention.  This effect was particularly marked for patients admitted at night.  Hospital and ICU length of stay were also lower, by a substantial amount.  The percent of patients using ventilation and the length of ventilation was also decreased.  There was higher adherence to most best practice guidelines and rates of complication were lower.   The intervention using the remote monitoring team appeared highly successful in improving care.  While the economics were not specifically calculated, it would appear that overall costs and spending had to be lower as well.