Telemedicine Used to Monitor ICU Patients Not Linked to Survival

Remote monitoring of patients in intensive care units (ICUs) is not associated with an overall improvement in their risk of death or length of stay in the ICU or hospital, according to a new study.

Researchers at the University of Texas Health Science Center (Houston, USA) assessed the effect of a tele-ICU intervention on mortality, complications, and length of stay (LOS) in 2,034 patients before the system was implemented (January 2003 to August 2005), and in 2,108 patients after the system was in place (July 2004 to July 2006). Tele-ICU physicians conducted rounds based on subjective assessments of illness severity. The physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%); the other patients in the post-intervention group had physicians who chose minimal delegation to the tele-ICU, in which case the tele-ICU intervened only for patients in life-threatening situations.

The researchers found that the observed hospital mortality rates were 12% in the preintervention period and 9.9% in the postintervention period. After adjustment for severity of illness, there were no significant differences associated with the tele-ICU intervention for hospital mortality. ICU mortality rates were 9.2% in the preintervention period and 7.8% in the postintervention period, with the difference also not significant after adjustment. The observed average hospital LOS among patients who survived to discharge was 9.8 days preintervention and 10.7 days postintervention; the observed average ICU LOS for the patients who survived to transfer was 4.3 days for the preintervention period compared to 4.6 days for the postintervention period, with neither difference significant. The study was published in the December 23, 2009, issue of the Journal of the American Medical Association (JAMA).

"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,” said lead author Eric J. Thomas, M.D., M.P.H., of the department of internal medicine. "The lack of apparent benefit may be attributable to low decisional authority granted to the tele-ICU, as well as to varied effects across different types of patients.”

"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,” concluded the authors.

The tele-ICU system, which was installed in 6 ICUs of 5 hospitals in a large U.S. health care 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.

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University of Texas Health Science Center