Remote monitoring for ICU patients not associated with shorter hospital stays

Remote monitoring of patients in intensive care units (ICUs) was not associated with an overall improvement in the risk of death or length of stay in the ICU or hospital, according to a study in the December 23/30 issue of the Journal of the American Medical Association.

Experts recommend that intensive care physicians care for ICU patients on-site because of an associated lower rate of illness and death. “However, there is a shortage of intensivists, which has led to the use of telemedicine technology to allow intensivists to remotely and simultaneously care for patients in several ICUs, thus extending their reach,” the authors write.

Eric J. Thomas, MD, MPH, of the University of Texas Health Science Center at Houston, and colleagues assessed the effect of a “tele-ICU” intervention on mortality, complications, and length of stay in six ICUs of five hospitals in a large U.S. healthcare system by measuring these outcomes before and after implementation of the tele-ICU. The study included 2,034 patients in the pre-intervention period and 2,108 patients in the post-intervention period. Almost two-thirds of the patients in the post-intervention group had physicians who chose minimal delegation to the tele-ICU, in which the tele-ICU intervened only for patients in life-threatening situations. Physicians delegated full treatment authority to the tele-ICU for almost one-third of patients.

The researchers found that the observed hospital mortality rates were 12.0 percent in the pre-intervention period and 9.9 percent in the post-intervention period. After adjustment for severity of illness, no significant differences were associated with the telemedicine intervention for hospital mortality. ICU mortality rates were 9.2 percent in the pre-intervention period and 7.8 percent in the post-intervention period, with the difference also not significant after adjustment.

The observed average hospital length of stay among patients who survived to discharge was 9.8 days pre-intervention and 10.7 days post-intervention; the observed average ICU length of stay for the patients who survived to transfer was 4.3 days for the pre-intervention period versus 4.6 days for the post-intervention period, with neither difference significant.

“Given the expense of tele-ICU technology, the conflicting evidence about its effectiveness, and the existence of other effective quality improvement interventions for ICUs, further use of this technology should proceed in the context of careful monitoring of patient outcomes and costs,” the authors concluded.