A large-scale multi-center study of the effects of use of telemedicine in the intensive care unit for adult care showed significant improvements in patient care and lower costs. The results of the study were released today in the CHEST Journal Online First, a publication of the American College of Chest Physicians.
The study examined the effects of the use of a telemedicine ICU program (the eICU program, supplied by Royal Philips, based in the Netherlands), which uses bi-directional audio-video technology, population management tools, clinical decision support, real-time and retrospective reporting tools, and targeted process redesign. The study, “A Multi-center Study of Telemedicine Reengineering of Adult Critical Care,” looked at the impact of the program on 118,990 critical care patients, across 56 ICUs, 32 hospitals and 19 health systems over a five-year period, and demonstrated reductions in both mortality and length of stay.
Among the key findings were that, compared to patients receiving conventional ICU care, patients using the telemedicine ICU program were:
- 26 percent more likely to survive the ICU;
- Discharged from the ICU 20 percent faster;
- 16 percent more likely to survive hospitization and be discharged; and
- Discharged from the hospital 15 percent faster.
“This is the first large-scale study that ties ICU telemedicine to both the improvement of patient outcomes and cost reduction through shorter length of stays in the ICU and hospital and identifies the processes that achieved greater efficiency,” according to Craig Lilly, M.D., professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School and director of the eICU program at UMass Memorial Medical Center, who is the study’s lead author.
The study used the American College of Chest Physicians ICU Telemedicine Survey instrument to measure data describing characteristics of each ICU, process of care, and structural and organizational characteristics before and after the implementation of the ICU telemedicine program. The results were statistically significant on both an unadjusted and severity-adjusted basis.
In a telephone interview, Dr. Lilly said, “The study demonstrates that if you use really high-quality tools and motivated and talented people, that you can shift the paradigm; you can save lives and you can save money at the same time.” He added that the study is large enough, that it provides some insights as to ICU telemedicine works, and where its use makes sense. He noted that not everybody that implemented the ICU telemedicine tools did it in the same way. By using the validated survey instrument, the researchers were able to identify factors that made a difference in better patient care.
The most important factor was the ability of the critical care specialist to either create a care plan or to review it within an hour of the time that the patient arrived in the hospital. “Of the places that did that, that was the biggest thing that it affected all four outcomes,” he said.
The study revealed the following program design elements common to the most successful ICU telehealth programs, including:
- Having an intensivist physician perform a remote review of the patient and care plan within one hour of ICU admission;
- Frequent collaborative review and use of performance data provided by the ICU telemedicine program;
- Faster response times to technology-based alerts and alarms for physiological and laboratory value instability;
- Increased rates of adherence to ICU best practices for those that are supported by the ICU telemedicine team;
- Interdisciplinary rounds; and
- Institutional ICU committee effectiveness.