Research shows benefits of tele-ICU
Tuesday, December 10, 2013
The medical community has been debating the value and meaningful use of the tele-ICU. No, not that "meaningful use" that sends shivers down your spine as you imagine government timelines and expectations.
For more than 25 years, the concept and practice of critical care medicine remotely has been in existence. For years, there have been debates — similar to those in the early use of bedside intensivists — of whether tele-ICU programs can save lives and reduce both ICU and hospital length of stay.
Much of the argument against the value of the tele-ICU comes from a small group of physicians who have demonstrated in small studies that there is no difference or perhaps worse outcomes than on-site intensivist programs.
The importance of this question is highlighted from the reality, both currently as well as the future, that we simply do not have an adequate supply of intensivists. Therefore, many think one of the most logical solutions is the utilization of teleintensivists for hospitals that either have no intensivists on-site or need more.
On Dec. 5, the journal CHEST published "A Mutli-center Study of ICU Telemedicine Reengineering of Adult Critical Care" by Dr. Craig Lilly and the University of Massachusetts Memorial Critical Care Operation Group. The importance of this study is that it is the most comprehensive study to date that shows that tele-ICU programs are associated with lower mortality and length of stay in both the ICU and hospital.
Lilly and colleagues have taken a further step from their previous study that showed that compliance to evidence-based guidelines and best practices contributed to better outcomes. Additionally, as one would suspect, better chances for survival come from timely responses to alerts for physiologic instability and earlier involvement of the true expert, the intensivist.
What distinguishes this study is that it overcame the problem of prior studies in that they did not have the power or number of patients to exclude statistical error. The Massachusetts study had 118,990 ICU patients, including a sizeable number of control patients.
The study shows that it's not just about having intensivists on-site or via telemedicine, but how they are engaged in patient management. The process of care is of the utmost importance as not only case management but also facilitating adherence to best practices, interdisciplinary rounding, utilization of performance data, improving ICU committee effectiveness along with other processes are key to better outcomes.
Finally, to balance out the results of the study, all of the individual benefits of a tele-ICU program are all additive with no single observation having any more significance than the others. This is a major study that reveals the true value of a tele-ICU program — or another term that some prefer, an ICU telemedicine program. Below is a quick look chart at some of the key values from the study.
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Should hospitals adopt tele-ICUs?
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