Telemedicine in ICU saves lives, studies find

In facilities where 24/7 intensive care was not available, outcomes were better when care was delivered by “tele-intensivists” compared to traditional models of care, researchers said.

Among patients treated at one of nine hospitals within the Cleveland Clinical Health System, those who received ICU telemedicine were 18% more likely to die and were discharged from hospital 2 days earlier than patients who received traditional ICU care, without intensive on-site care.

The results of the study, which included approximately 154,000 ICU patients, were presented at the Association of Critical Care Medicine’s 50th Critical Care Congress Congress.

Cleveland Clinic specialist Chiedozie Udeh, MD, who presented the findings, noted that the COVID-19 pandemic has attracted the attention of telemedicine ICU.

“In a world that is great, bedside patients would be mentally intensive 24/7, but the reality is that even if we had all the money in the world, there are no trained professionals to We have enough to do the job, “Udeh said.

An intensive telemedicine examiner has access to examiners, medical records and test results and can do everything an on-site clinician can do, except have physical communication with the patient, said Udeh.

While based at a remote command center, the psychiatrist monitors a record of patients at various hospitals, using real-time two-way audio-visual communication to interact with nurses. side of the bed.

Specific software typically includes decision support tools designed to identify patients who may be degenerative and in need of additional care.

In an interview with MedPage today, Udeh said ICU telemedicine, which is now used in about 20% of U.S. hospitals, offers an intermediate treatment strategy between 24/7 intensive care, which is a rare side effect. outside large academic institutions, and the more traditional ICU model of care, in which intensive care may be on-site at certain times of the day but others are not.

He said more research is needed to better understand why ICU-telemonitoring leads to fewer deaths.

“If I had to make a profit I would think that this might be a result of patients getting needed interventions sooner,” he said.

The Cleveland Clinic Health System established an ICU telemedicine program in 2014 to support ICUs within the system.

The retrospective study was conducted to measure 20-day mortality among ICU patients treated at one of Cleveland Clinic’s nine hospitals from 2010 to 2019.

During the period, enrollment data recorded just over 642,000 patients treated in the various ICUs. The current analysis covered 153,987 patients with available data on predictive death, measured by APACHE IV scores.

In the decade following, 108,482 patients included in the study (70%) received ICU telemedicine care during hours when there was no on-site intensive care.

Patients in the ICU telemedicine group were slightly older on average (68.9 years versus 66.7 years), and were more likely to be non-white and have a lung ICU diagnosis, ICU admission for heart attack, or emergency admissions and / or weekends.

Key findings of the survey include:

• 30-day mortality remained unchanged among telemedicine patients at 5.5% compared with 6.9% in the standard care group (P.<0.0001)
• 30-day mortality per 1,000 patient days was 2.45 in the ICU group and 3.18 in the non-ICU group (P.<0.0001).
• Variables associated with increased 30-day mortality included non-white race, diagnosis of sepsis or heart attack, emergency admission, and weekend admission.
• ICU telemedicine duration was significantly shorter in the ICU telemedicine group, as was hospital stay as a whole.

“We believe these findings provide further reassurance about the value of ICU telemedicine, particularly given our shared experience in 2020,” Udeh said. “With the COVID-19 pandemic , telemedicine in general was gaining more prominence. “

He said MedPage today that telemedicine ICU can benefit both large hospital systems and smaller hospitals, respectively.

“Smaller hospitals may not be at an intensive level or they may only have one,” he said. One recent study, he said, found that about half of U.S. hospitals are not staff-intensive.