Does ICU Telemedicine Improve Outcomes? Current State of the Evidence
Onsite staffing by intensivists has been associated with lower morbidity and mortality. However, there is an existing gap that is widening between intensivist workforce and patient demand. Tele-ICU has been proposed as an efficient method for intensivist care as it offers the possibility of reducing latency response times to urgent pages, providing inpatient consultation in areas where an intensivist is not immediately available, increasing adherence to best practices, and providing monitoring via a technology bundle that may not otherwise exist.
To date, existing studies of tele-ICU effectiveness have had mixed results. Although ICU mortality has been consistently reduced by tele-ICU implementation, secondary outcomes such as hospital mortality and hospital length of stay have not been consistently shown a benefit. Differing technology configuration, baseline ICU organizational characteristics, case mix of the implementation site, and the “dose” of the intervention may be responsible for these discrepancies. ICUs most likely to benefit from tele-ICU seem to have less infrastructure by way of quality audit and feedback processes. However, the existing evidence is limited by the absence of randomized or quasi-randomized trials of tele-ICU implementation and relies only on before-after observational designs.
As tele-ICU implementation carries the burden of significant cost and upkeep, a number of groups are investigating the core components responsible for reported benefit with the hopes of improving its cost-effectiveness. It seems that technology implementation is insufficient to ensure effectiveness, and as such concentrated efforts to systems reengineering and promoting a strong culture of collaboration between caregiving parties are of paramount importance.
KeywordsTele-ICU Implementation guidelines Outcomes Systems reengineering Cost-effectiveness
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