Clinical question: Does remote ICU monitoring improve mortality and length of stay?
Background: A shortage of intensivists has led to increased use of remote ICU monitoring or telemedicine technology to allow intensivists to remotely and simultaneously care for patients in multiple ICUs. Data evaluating this practice have been limited.
Study design: Pre- and postintervention observational study.
Setting: Open and closed medical-surgical ICUs in community, urban, and tertiary-care teaching U.S. hospitals.
Synopsis: This observational study in six ICUs aimed to assess the association of a telemedicine intervention with clinical outcomes. The intervention consisted of a remote office with real-time audiovisual monitoring, vital signs, early warning signals, and other electronic data. Comparing preintervention (n=2,034) and postintervention (n=2,108) groups, there were no differences in mortality, LOS, or complications.
Overall, the general limitation of the study was that integration of the tele-ICU and actual ICUs was limited. Physicians for nearly two-thirds of the patients chose “minimal delegation” to the tele-ICU physician. Tele-ICU involvement was particularly limited in “closed” units, which were already staffed by on-site intensivists. Furthermore, despite access to various real-time data, critical elements of the record such as physician order entry and progress notes were not shared in real time; notes, for example, required daily faxing.
While it is unfortunate that the study could not evaluate the full potential of the adjunctive tele-ICU, it illustrates the real-world obstacles of integrating such technology into clinical practice. In future studies, a standardized telemedicine approach might facilitate evaluation efforts.
Bottom line: While this study demonstrated no benefit of telemedicine, study limitations preclude conclusions. Further studies are needed.
Citation: Thomas EJ, Lucke JF, Wueste L, Weavind L, Patel B. Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay. JAMA. 2009;302(24):2671-2678.
Dr. Kim is a hospitalist at Brigham and Women's Hospital in Boston, and an instructor at Harvard Medical School.
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