Safety and Quality Metrics for ICU Telemedicine: Measuring Success

  • Ramesh Venkataraman
  • Nagarajan RamakrishnanEmail author


Patients in the intensive care unit (ICU) warrant continuous monitoring and titration of care by qualified personnel. However, there has been a shortage of trained intensivists and round the clock availability further adds stress to the existing discrepancy in the supply and demand. Moreover, such a model also will contribute to physician fatigue and burn out. Remote monitoring of ICU patients from a central location provides for an efficient mechanism to optimally utilize the existing manpower while balancing the supply demand mismatch. Remote ICU or Tele-ICU intuitively should increase the quality and safety of care provided. However, data regarding this is conflicting. The variation in impact of tele-ICU on these outcomes stems from the type of ICU it is provided in, the model of care provision, its local acceptance, and the metrics evaluated. In this chapter we have addressed the existing literature on the effects of tele-ICU on patient safety and quality of care and the indices that have been studied to evaluate this.


Telemedicine Tele-ICU Virtual ICU Quality of care Patient safety 


  1. 1.
    Davis TM, Barden C, Dean S, Gavish A, Goliash I, Goran S, et al. American Telemedicine Association guidelines for teleICU operations. Telemed e-Health. 2016;22(12):971–80.CrossRefGoogle Scholar
  2. 2.
    Reynolds HN, Bander J, McCarthy M. Different systems and formats for tele-ICU coverage: designing a tele-ICU system to optimize functionality and investment. Crit Care Nurs Q. 2012;35(4):364–77.CrossRefGoogle Scholar
  3. 3.
    Kahn JM, Hill NS, Lilly CM, Angus DC, Jacobi J, Rubenfeld GD, et al. The research agenda in ICU telemedicine: a statement from the Critical Care Societies Collaborative. Chest. 2011;140(1):230–8.CrossRefGoogle Scholar
  4. 4.
    Venkataraman R, Ramakrishnan N. Outcomes related to telemedicine in the intensive care unit. Crit Care Clin. 2015;31(2):225–37.CrossRefGoogle Scholar
  5. 5.
    Lilly CM, Thomas EJ. Tele-ICU: experience to date. J Intensive Care Med. 2010;25(1):16–22.CrossRefGoogle Scholar
  6. 6.
    Khunlertkit A, Carayon P. Contributions of tele–intensive care unit (Tele-ICU) technology to quality of care and patient safety. J Crit Care. 2013;28(3):315.e1–315.e12.CrossRefGoogle Scholar
  7. 7.
    Lilly CM, McLaughlin JM, Zhao H, Baker SP, Cody S, Irwin RS, et al. A multicenter study of ICU telemedicine reengineering of adult critical care. Chest. 2014;145(3):500–7.CrossRefGoogle Scholar
  8. 8.
    Horner DL, Bellamy MC. Care bundles in intensive care. Contin Educ Anaesth Crit Care Pain. 2012;12(4):199–202.CrossRefGoogle Scholar
  9. 9.
    Youn BA. ICU process improvement: using telemedicine to enhance compliance and documentation for the ventilator bundle. Chest. 2006;130:226s–C.CrossRefGoogle Scholar
  10. 10.
    Forni A, Skehan N, Hartman CA, Yogaratnam D, Njoroge M, Schifferdecker C, et al. Evaluation of the impact of a tele-ICU pharmacist on the management of sedation in critically III mechanically ventilated patients. Ann Pharmacother. 2010;44(3):432–8.CrossRefGoogle Scholar
  11. 11.
    Cowboy EN, Nygaard SD, Robin Simmons JS. Compliance with CMS timely referral and organ procurement impact via tele ICU. Chest. 2009;136(4):15S–b.Google Scholar
  12. 12.
    Kalb T, Raikhelkar J, Meyer S, Ntimba F, Thuli J, Gorman MJ, et al. A multicenter population-based effectiveness study of teleintensive care unit–directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality. J Crit Care. 2014;29(4):691.e7–691.e14.CrossRefGoogle Scholar
  13. 13.
    Ries M. Tele-ICU: a new paradigm in critical care. Int Anesthesiol Clin. 2009;47(1):153–70.CrossRefGoogle Scholar
  14. 14.
    Rincon TA, Bourke G, Seiver A. Standardizing sepsis screening and management via a tele-ICU program improves patient care. Telemed e-Health. 2011;17(7):560–4.CrossRefGoogle Scholar
  15. 15.
    Patel B, Kao L, Thomas E, Young E. Improving compliance with surviving sepsis campaign guidelines via remote electronic ICU monitoring. Crit Care Med. 2007;35:A275.CrossRefGoogle Scholar
  16. 16.
    Ikeda D, Hayatdavoudi S, Winchell J, Rojas A, Rincon T, Yee A. Implementation of a standard protocol for the surviving sepsis 6 and 24 hr bundles in patients with an APACHE III admission diagnosis of sepsis decreases mortality in an open adult ICU: 8. Crit Care Med. 2006;34(12):A2.CrossRefGoogle Scholar
  17. 17.
    Grundy BL, Crawford P, Jones PK, Kiley ML, Reisman A, Pao YH, et al. Telemedicine in critical care: an experiment in health care delivery. JACEP. 1977;6(10):439–44.CrossRefGoogle Scholar
  18. 18.
    Rosenfeld BA, Dorman T, Breslow MJ, Pronovost P, Jenckes M, Zhang N, et al. Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Crit Care Med. 2000;28(12):3925–31.CrossRefGoogle Scholar
  19. 19.
    Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(21):2175–83.CrossRefGoogle Scholar
  20. 20.
    Chen J, Sun D, Yang W, Liu M, Zhang S, Peng J, et al. Clinical and economic outcomes of telemedicine programs in the intensive care unit: a systematic review and meta-analysis. J Intensive Care Med. 2018;33(7):383–93.CrossRefGoogle Scholar
  21. 21.
    Kahn JM, Le TQ, Barnato AE, Hravnak M, Kuza CC, Pike F, et al. ICU telemedicine and critical care mortality. Med Care. 2016;54(3):319–25.CrossRefGoogle Scholar
  22. 22.
    Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med. 2011;171(6):498–506.CrossRefGoogle Scholar
  23. 23.
    Thomas EJ, Lucke JF, Wueste L, Weavind L, Patel B. Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay. JAMA. 2009;302(24):2671–8.CrossRefGoogle Scholar
  24. 24.
    Morrison JL, Cai Q, Davis N, Yan Y, Berbaum ML, Ries M, et al. Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals. Crit Care Med. 2010;38(1):2–8.CrossRefGoogle Scholar
  25. 25.
    Nassar BS, Vaughan-Sarrazin MS, Jiang L, Reisinger HS, Bonello R, Cram P. Impact of an intensive care unit telemedicine program on patient outcomes in an integrated health care system. JAMA Intern Med. 2014;174(7):1160–7.CrossRefGoogle Scholar
  26. 26.
    Collins TA, Robertson MP, Sicoutris CP, Pisa MA, Holena DN, Reilly PM, et al. Telemedicine coverage for post-operative ICU patients. J Telemed Telecare. 2017;23(2):360–4.CrossRefGoogle Scholar
  27. 27.
    Van Gent J-M, Davis KL, Henry N, Zander AL, Kuettel MA, Edson T, et al. The initial impact of tele-critical care on the surgical services of a Community Military Hospital. Mil Med. 2018;183:e494–9.CrossRefGoogle Scholar
  28. 28.
    Schwamm LH, Rosenthal ES, Hirshberg A, Schaefer PW, Little EA, Kvedar JC, et al. Virtual teleStroke support for the emergency department evaluation of acute stroke. Acad Emerg Med. 2004;11(11):1193–7.CrossRefGoogle Scholar
  29. 29.
    Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, et al. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke. 2010;41(1):e18–24.CrossRefGoogle Scholar
  30. 30.
    Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012;43(8):2078–85.CrossRefGoogle Scholar
  31. 31.
    Machado SM, Wilson EH, Elliott JO, Jordan K. Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department. J Telemed Telecare. 2018;24(3):202–8.CrossRefGoogle Scholar
  32. 32.
    Moeckli J, Cram P, Cunningham C, Reisinger HS. Staff acceptance of a telemedicine intensive care unit program: a qualitative study. J Crit Care. 2013;28(6):890–901.CrossRefGoogle Scholar
  33. 33.
    Young LB, Chan PS, Cram P. Staff acceptance of tele-ICU coverage: a systematic review. Chest. 2011;139(2):279–88.CrossRefGoogle Scholar
  34. 34.
    Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Critical Care MedicineApollo HospitalsChennaiIndia

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