Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care

Objective: Intensive care units (ICUs) account far an increasing percentage of hospital admissions and resource consumption. Adverse events are common in ICU patients and contribute to high mortality rates and costs. Although evidence demonstrates reduced complications and mortality when intensivist s manage ICU patients, a dramatic national shortage of these specialists pr ecludes most hospitals from implementing an around-the-clock, on-site inten sivist care model. Alternate strategies are needed to bring expertise and p roactive, continuous care to the critically ill. We evaluated the feasibili ty of using telemedicine as a means of achieving 24-hr intensivist oversigh t and improved clinical outcomes. Design: Observational time series triple cohort study. Setting: A ten-bed surgical ICU in an academic-affiliated community hospita l. Patients: All patients whose entire ICU stay occurred within the study peri ods. Interventions: A 16-wk program of continuous intensivist oversight was inst ituted in a surgical ICU, where before the intervention, intensivist consul tation was available but there were no on-site intensivists. Intensivists p rovided management during the intervention using remote monitoring methodol ogies (video conferencing and computer-based data transmission) to obtain c linical information and to communicate with on-site personnel. To assess th e benefit of the remote management program, clinical and economic performan ce during the intervention were compared with two 16-wk periods within the year before the intenrentian, Measurements and Main Results: ICU and hospital mortality (observed and Acu te Physiology and Chronic Health Evaluation ill, severity-adjusted), ICU co mplications, ICU and hospital length-of-stay, and ICU and hospital costs we re measured during the 3 study periods. Severity-adjusted ICU mortality dec reased during the intervention period by 68% and 46%, compared with baselin e periods one and two, respectively, Severity-adjusted hospital mortality d ecreased by 33% and 30%, and the incidence of ICU complications was decreas ed by 44% and 50%. ICU length of stay decreased by 34% and 30%, and ICU cos ts decreased by 33% and 36%, respectively. The cast savings were associated with a lower incidence of complications. Conclusions: Technology-enabled remote care can be used to provide continuo us ICU patient management and to achieve improved clinical and economic out comes. This intervention's success suggests that remote care programs may p rovide a means of improving quality of care and reducing costs when on-site intensivist coverage is not available.