Report Supports Telemedicine Use in ICU


A new report that outlines the potential care delivery improvements and cost savings of telemedicine might also be a road map to increased efficiency for hospitalists, according to one of the study’s authors and a former SHM president.

Telemedicine "simplifies their life," says Mitchell Adams, AB, MBA, executive director of the Massachusetts Technology Collaborative (MTC) in Boston, which coauthored "Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care" with the New England Healthcare Institute (NEHI) in Cambridge. "It means you have you less complications, you have less work. You have an intensivist looking over your shoulder, making sure you’re doing it right."

As the population ages and hospitalists become more entrenched in their institutions, they could end up spending more time on ICU cases. The use of telemedicine—where an intensivist at a remote “command center” oversees the delivery of care—could foster higher-quality and more efficient care, which would subsequently allow HM practitioners to focus on the rest of the census, according to Mary Jo Gorman, MD, MBA, FHM, former SHM president and CEO of St. Louis-based Advanced ICU Care, which provides intensivists to community hospitals using telemedicine.

The study, based on a demonstration project at the University of Massachusetts Memorial Medical Center and two associated community hospitals, reported a 20% drop in ICU mortality at the academic medical center (P=0.01). When adjusted for the severity of ICU illnesses, one community hospital reported a 36% drop in mortality (P=0.83); the other reported a 142% increase (P<0.001). All three centers also reported a reduction in length of stay (LOS) of at least 12 hours.

Dr. Gorman and Adams agree that it will take more evidence-based studies showing the efficacy of telemedicine before the practice becomes widespread, a phenomenon Adams attributes to the "inherent inertia and viscosity in the system to maintain the status quo."

"Everybody might know the right answer," Dr. Gorman adds. "It's still going to take a long time. That’s just the pace at which we move in healthcare."

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