Patients in ICU Need Care Thats There
Reported January 05, 2010
(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