Thursday, December 31, 2009

Telemedicine and ICU outcomes

Telemedicine, defined as the "use of electronic information and communication technologies to provide health care when the caregiver and patient are geographically distanced," is an increasing trend in inpatient medicine.

A recent article published in the Journal of the American Medical Association (JAMA) shows that the use of telemedicine for remote patient monitoring was not associated with an overall improvement in mortality or length of stay in the intensive care unit (ICU) setting. Since some hospitals face a shortage of intensive care unit physicians (intensivists), they rely on telemedicine to allow intensivists to monitor patients from remote locations. Can you imagine being in a room filled with monitors, TV screens, microphones, and computers? How in the world are you supposed to follow what's going on with everyone? It's difficult enough to maintain proper ventilator settings, adjust pressors to optimize perfusion without causing tissue necrosis, and remember which IV drips are running on each patient. Could you do all of this from a remote location?

So the objective of the study was: To assess the association of remote monitoring of ICU patients (ICU telemedicine [tele-ICU]) with mortality, complications, and length of stay (LOS).

Here's a summary of the study design:
Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of tele-ICU. The study included 2034 patients in the preintervention period (January 2003 to August 2005) and 2108 patients in the postintervention period (July 2004 to July 2006).
Now, what are we supposed to conclude based on this study? Considering that some of the early studies are from 2003, that seems like a long time ago when we look at how quickly communications technology has advanced. If we were to repeat the same study with modern computes and telecommunications, perhaps the outcome would be different. What are we to conclude from this observational study? Will we see randomized control trials designed to evaluate the efficacy of telemedicine in the ICU? I don't think so. If you were a critically ill patient, would you rather have a remote doctor or an in-hospital doctor taking care of you?

To read the abstract on JAMA, click here.

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