Tele-ICU?

Since inception of Tele-ICU (famously called eICU) about a decade ago, debate about its utility remained controversial. This month JAMA published a study to quantify the association of a tele-ICU intervention with hospital mortality, length of stay, and complications that are preventable by adherence to best practices. Study include 6290 adults admitted to 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on 2 campuses of an 834-bed academic medical center from April 26, 2005, through September 30, 2007. Electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms were evaluated.

Results

• The hospital mortality rate was 13.6% during the preintervention period compared with 11.8% during the tele-ICU intervention period.



• The tele-ICU intervention period compared with the preintervention period was associated with higher rates of best clinical practice adherence for the prevention of deep vein thrombosis (99% vs 85%) and prevention of stress ulcers (96% vs 83%), best practice adherence for cardiovascular protection (99% vs 80%), prevention of ventilator-associated pneumonia (52% vs 33%), for catheter-related bloodstream infection and shorter hospital length of stay (9.8 vs 13.3 days).



• The results for medical, surgical, and cardiovascular ICUs were similar.

Authors concluded that implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with changes in best practice adherence and lower rates of preventable complications.

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):2175-2183.Published online May 16, 2011