Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care

• HIT Description: Telemedicine More info...
  
• Purpose of Study: To compare usual care with 24 hour intensivist oversight of the intensive care unit via telemedicine.
  
• Years of study: 1996-1997
  
• Study Design: Before and after, with two baseline periods.
  
• Outcomes: linical outcomes and economic outcomes.
  

• Settings: A surgical intensive care unit in a 450 bed academic affiliated hospital.
• Intervention: 24 hour monitoring of all ICU patients from the home of an intensivist who interacted with patients and hospital personnel and access clinical data via dedicated computer-based video conferencing and data transmission equipment; comparison group was two different baseline periods.
• Evaluation Method: Chart abstraction and measurement of patient outcomes and cost data.
• Description: Video conferencing equipment that enabled directed visualization of patients and staff in communication with onsite caregivers. Bedside monitoring data were transmitted in real time via a telephone access system developed by Space Labs Medical, Seattle, WA. Electrocardiograms, radiographs, consultant notes, and bedside data flowsheets were scanned and transmitted digitally. Lab data were accessed through a telephone terminal emulation system.
• Cost of Implementation: Authors note that there was a two week training period before the intervention began.
• Healthcare Utilization: Length of stay in the ICU during the intervention period was reduced by 26% compared to baseline period one and 35% compared to baseline period two.
• Quality of Care and Patient Safety Outcome: Comparison of ICU mortality during intervention and control periods, using observed mortality with that expected via APACHE III, yielded a reduction in mortality of 32% compared to baseline period one and 58% compared to baseline period two. The incidence of ICU complications were 15.1% and 18.8% in the baseline periods and 9.5% in the intervention period.
• Changes in healthcare costs: Intensive care unit costs were reduced by 25% and 31% in the intervention period compared to baseline periods one and two. Total hospital costs were 12% and 19% lower respectively, although these differences were not statistically significant. Decrease in ICU cost was mostly attributable to lower routine costs, lower radiology, and therapy costs.�