A multicenter study of ICU telemedicine reengineering of adult critical care
Department of Medicine; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences; Department of Quantitative Health Sciences; Graduate School of Nursing
Critical Care | Health Services Administration | Health Services Research | Nursing | Pathological Conditions, Signs and Symptoms | Telemedicine
BACKGROUND: Few studies have evaluated both the overall effect of ICU telemedicine programs and the effect of individual components of the intervention on clinical outcomes.
METHODS: The effects of nonrandomized ICU telemedicine interventions on crude and adjusted mortality and length of stay (LOS) were measured. Additionally, individual intervention components related to process and setting of care were evaluated for their association with mortality and LOS.
RESULTS: Overall, 118,990 adult patients (11,558 control subjects, 107,432 intervention group patients) from 56 ICUs in 32 hospitals from 19 US health-care systems were included. After statistical adjustment, hospital (hazard ratio [HR]=0.84; 95% CI, 0.78-0.89; P < .001) and ICU (HR=0.74; 95% CI, 0.68-0.79; P < .001) mortality in the ICU telemedicine intervention group was significantly better than that of control subjects. Moreover, adjusted hospital LOS was reduced, on average, by 0.5 (95% CI, 0.4-0.5), 1.0 (95% CI, 0.7-1.3), and 3.6 (95% CI, 2.3-4.8) days, and adjusted ICU LOS was reduced by 1.1 (95% CI, 0.8-1.4), 2.5 (95% CI, 1.6-3.4), and 4.5 (95% CI, 1.5-7.2) days among those who stayed in the ICU for > /=7, > /=14, and > /=30 days, respectively. Individual components of the interventions that were associated with lower mortality, reduced LOS, or both included (1) intensivist case review within 1 h of admission, (2) timely use of performance data, (3) adherence to ICU best practices, and (4) quicker alert response times.
CONCLUSIONS: ICU telemedicine interventions, specifically interventions that increase early intensivist case involvement, improve adherence to ICU best practices, reduce response times to alarms, and encourage the use of performance data, were associated with lower mortality and LOS.
DOI of Published Version
Chest. 2014 Mar 1;145(3):500-507. doi: 10.1378/chest.13-1973. Link to article on publisher's site
Lilly, Craig M.; McLaughlin, John M.; Zhao, Huifang; Baker, Stephen P.; Cody, Shawn; and Irwin, Richard S., "A multicenter study of ICU telemedicine reengineering of adult critical care" (2014). Graduate School of Nursing Publications and Presentations. 79.