Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System

Abstract

We evaluated the impact of a 15-hospital, rural, multi-state intensive care unit (ICU) telemedicine program. Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) scores, raw mortality rates, and actual-to-predicted length of stay (LOS) ratios and mortality ratios were used. Surveys evaluated program impact in smaller facilities and satisfaction of the physicians staffing the remote center. Smaller facilities' staff reported improvements in the quality of critical care services and reduced transfers. In regional hospitals, acuity scores increased (retention of sicker patients) while raw mortality was the same or lower. Length of stay ratios were reduced in these hospitals. In the tertiary hospital, actual-to-predicted ICU and hospital mortality and LOS ratios decreased.

Avera eCARE®, a Comprehensive Telemedicine Program for the Rural North Central Region of the United States

“…We therefore conducted a study in which we compared these measurements over the 2.5 year period after implementation of the eICU ® to two year's worth of randomly sampled charts before the implementation. 2 Figure 14 demonstrates that there was a statistically significant improvement in these outcomes with the initiation of this telemedicine clinical program.…”

“…2 We continue to record this in our quarterly quality reports. Figure 15 illustrates this calculation before vs. after the project was begun.…”

Voices of Family Members and Significant Others in the Tele–Intensive Care Unit

“…The study was approved by the institutional review boards at each of the 3 participating health systems. 15 Franzini et al 16 Zawada et al 17 Young .007…”

“…16 Mortality rates, ICU LOS, and hospital LOS were compared 1 year before and 2 years after implementation of an ICU telemedicine program at a tertiary-care center. 17 After adjustment for mortality predicted on the basis of scores on the Acute Physiology and Chronic Health Evaluation (APACHE), significantly lower ICU mortality rates were evident during implementation of the tele-ICU (odds ratio, 0.35; P=.007). Severity-adjusted LOS was calculated as the difference between actual and predicted LOS in the ICU and hospital.…”

“…Severity-adjusted LOS decreased significantly from 0.17 to -1.49 days in the ICU (P=.001) with a similar decrease in hospital LOS from -0.84 days before implementation to -2.64 days after implementation of the tele-ICU (P=.001). 17 A meta-analysis 18 of 13 studies involving 35 ICUs and 41375 patients, with each study using a before-and-after design demonstrated significant decreases in both ICU mortality and LOS. The pooled odds ratio for ICU mortality was 0.80 (95% CI, 0.66-0.97; P=.02), and there was a mean decrease of 1.26 days (95% CI, -2.1 to -0.30 days; P=.01) for ICU LOS.…”