Implementation of a Remote Intensive Care Unit Monitoring System Correlates With Improvements in Patient Outcomes

Howell, Gregory; Ardilles, Thomas; Bonham, Aaron J.

doi:10.1378/chest.134.4_meetingabstracts.s58003

Cited by 9 publications

(10 citation statements)

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“…Probable mechanisms for this improvement include greater levels of participation of the Tele-ICU team in implementing patient care and improved coordination with bedside caregivers ( 41 ). In another study, it was observed that severity-adjusted ICU LOS significantly improved from 0.84 to –0.03 (or 4,772 saved ICU days; p < 0.001) and severity-adjusted hospital LOS improved from 0.97 to –0.64 (or 6,091 saved floor days; p = 0.001) ( 42 ). In a study evaluating 15 rural multistate ICUs, Tele-ICU implementation was associated with lower mortality and LOS in ICUs ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Armaignac

Saxena

Rubens

et al. 2018

Critical Care Medicine

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Objectives:To determine whether Telemedicine intervention can affect hospital mortality, length of stay, and direct costs for progressive care unit patients.Design:Retrospective observational.Setting:Large healthcare system in Florida.Patients:Adult patients admitted to progressive care unit (PCU) as their primary admission between December 2011 and August 2016 (n = 16,091).Interventions:Progressive care unit patients with telemedicine intervention (telemedicine PCU [TPCU]; n = 8091) and without telemedicine control (nontelemedicine PCU [NTPCU]; n = 8000) were compared concurrently during study period.Measurements and Main Results:Primary outcome was progressive care unit and hospital mortality. Secondary outcomes were hospital length of stay, progressive care unit length of stay, and mean direct costs. The mean age NTPCU and TPCU patients were 63.4 years (95% CI, 62.9–63.8 yr) and 71.1 years (95% CI, 70.7–71.4 yr), respectively. All Patient Refined-Diagnosis Related Group Disease Severity (p < 0.0001) and All Patient Refined-Diagnosis Related Group patient Risk of Mortality (p < 0.0001) scores were significantly higher among TPCU versus NTPCU. After adjusting for age, sex, race, disease severity, risk of mortality, hospital entity, and organ systems, TPCU survival benefit was 20%. Mean progressive care unit length of stay was lower among TPCU compared with NTPCU (2.6 vs 3.2 d; p < 0.0001). Postprogressive care unit hospital length of stay was longer for TPCU patients, compared with NTPCU (7.3 vs 6.8 d; p < 0.0001). The overall mean direct cost was higher for TPCU ($13,180), compared with NTPCU ($12,301; p < 0.0001).Conclusions:Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in progressive care unit settings. Our study showed that TPCU intervention significantly decreased mortality in progressive care unit and hospital and progressive care unit length of stay despite the fact patients in TPCU were older and had higher disease severity, and risk of mortality. Increased postprogressive care unit hospital length of stay and total mean direct costs inclusive of telemedicine costs coincided with improved survival rates. Telemedicine intervention decreased overall mortality and length of stay within progressive care units without substantial cost incurrences.

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Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Armaignac

Saxena

Rubens

et al. 2018

Critical Care Medicine

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“…Study characteristics are provided in Table 1; an extended table can be found in Supplemental Digital Content 2 (http://links.lww.com/ CCM/G222). Eighteen studies were conducted in the United States (5,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(29)(30)(31)(32)(33)(34), one in India (28), and one in Germany (4); more than 589 academic or community urban or rural hospitals were involved overall. The type of ICU was medical, shock trauma, general surgical, medical-surgical, neurosurgical, cardiac, or mixed.…”

Section: Study Characteristicsmentioning

confidence: 99%

Decision-Making Authority During Tele-ICU Care Reduces Mortality and Length of Stay—A Systematic Review and Meta-Analysis*

Kalvelage

Rademacher

Dohmen

et al. 2021

Critical Care Medicine

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OBJECTIVES: Although the current coronavirus disease 2019 pandemic demonstrates the urgent need for the integration of tele-ICUs, there is still a lack of uniform regulations regarding the level of authority. We conducted a systematic review and meta-analysis to evaluate the impact of the level of authority in tele-ICU care on patient outcomes. DATA SOURCES: We searched MEDLINE, EMBASE, CENTRAL, and Web of Science from inception until August 30, 2020. STUDY SELECTION: We searched for randomized controlled trials and observational studies comparing standard care plus tele-ICU care with standard care alone in critically ill patients. DATA EXTRACTION: Two authors performed data extraction and risk of bias assessment. Mean differences and risk ratios were calculated using a random-effects model. DATA SYNTHESIS: A total of 20 studies with 477,637 patients (n tele-ICU care = 292,319, n control = 185,318) were included. Although “decision-making authority” as the level of authority was associated with a significant reduction in ICU mortality (pooled risk ratio, 0.82; 95% CI, 0.71–0.94; p = 0.006), we found no advantage of tele-ICU care in studies with “expert tele-consultation” as the level of authority. With regard to length of stay, “decision-making authority” resulted in an advantage of tele-ICU care (ICU length of stay: pooled mean difference, –0.78; 95% CI, –1.46 to –0.10; p = 0.14; hospital length of stay: pooled mean difference, –1.54; 95% CI, –3.13 to 0.05; p = 0.06), whereas “expert tele-consultation” resulted in an advantage of standard care (ICU length of stay: pooled mean difference, 0.31; 95% CI, 0.10–0.53; p = 0.005; hospital length of stay: pooled mean difference, 0.58; 95% CI, –0.04 to 1.21; p = 0.07). CONCLUSIONS: In contrast to expert tele-consultations, decision-making authority during tele-ICU care reduces mortality and length of stay in the ICU. This work confirms the urgent need for evidence-based ICU telemedicine guidelines and reveals potential benefits of uniform regulations regarding the level of authority when providing tele-ICU care.

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“…Disagreement about inclusion was resolved by discussion between the reviewers. In cases of multiple articles that appeared to present overlapping data from the same patient populations, 27,[31][32][33][34][35][36][37][38][39][40] we contacted the study authors and included data from the most comprehensive article while excluding the duplicate study. For 12 studies with incomplete data (eg, missing details on ICU characteristics or LOS data), we contacted the authors on at least 3 occasions during a 3-week period to request additional data.…”

Section: Study Selectionmentioning

confidence: 99%

Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes

Young¹,

Chan²,

Lü³

et al. 2011

Arch Intern Med

234

120

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Implementation of a Remote Intensive Care Unit Monitoring System Correlates With Improvements in Patient Outcomes

Cited by 9 publications

References 0 publications

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

Decision-Making Authority During Tele-ICU Care Reduces Mortality and Length of Stay—A Systematic Review and Meta-Analysis*

Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes

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