Telemedicine Intervention May Improve ICU Outcomes

A telemedicine intervention may improve patient outcomes in the intensive care unit (ICU), according to the results of a new study.

Researchers at the University of Massachusetts Medical School (UMMS; Worcester, USA) conducted a prospective stepped-wedge clinical practice study involving a total of 6,290 adults admitted to 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on 2 campuses of the 834-bed UMMS medical center. The investigators assessed electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms. The main study endpoints were hospital mortality adjusted for case-mix and severity; other endpoints included length of hospitalization and ICU stay, best practice adherence, and complication rates.

The results showed that during the preintervention period, hospital mortality rate was 13.6%; this rate decreased during the tele-ICU intervention period to 11.8%, yielding an adjusted odds ratio (OR) of 0.40. Compared with the preintervention period, rates of best clinical practice adherence were better during the tele-ICU intervention period regarding prevention of deep vein thrombosis (DVT), stress ulcer prevention, cardiovascular protection, and prevention of ventilator-associated pneumonia (VAP). In addition, rates of preventable complications were lower during the tele-ICU intervention period for VAP and catheter-related bloodstream infection. Additionaly, hospital length of stay was shorter. The findings were similar for medical, surgical, and cardiovascular ICUs. The study was published early online on May 16, 2011, in the Journal of the American Medical Association (JAMA).

"Tele-ICU can be defined as the provision of care to critically ill patients by health care professionals located remotely," concluded lead author Craig Lilly, MD, and colleagues. "A tele-intensive care unit (ICU) is a promising technological approach designed to systematically alter processes of care that affect outcomes."

"A successful telemedicine program will follow the basic tenets of quality improvement - performing a detailed needs assessment, assessing the barriers to practice change, prioritizing specific projects, introducing effective strategies for improvement, and measuring the results in a stepwise fashion," added Jeremy Kahn, MD, MS, of the University of Pittsburgh (PA, USA), in an accompanying editorial. "Similar to traditional quality improvement, an approach in which this technology is introduced without setting specific quality goals and defining clear quality improvement processes is likely to fail. Instead, it is important to define specific quality deficiencies in the target ICUs, and then design the telemedicine intervention specifically to address those deficiencies, akin to other types of quality improvement."

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