Remote management improves ICU outcomes

Introduction: Studies have demonstrated reduced mortality, length-of-stay (LOS) and resource utilization when intensive care units (ICU) are managed by on-site critical care specialists. We believe that a large part of the benefit of on-site Intensivists resides in continuous physiologic monitoring. We hypothesized that telemedical methodologies could provide similar patient monitoring. Accordingly, we investigated the effect of remote ICU management on clinical and economic outcomes. Methods: After IRB approval, a telecommunication system (HII, Inc., St. Louis, MO) was installed (with bi-directional data and video-conferencing) between remote Intensivists and a University-affiliated, community-based teaching hospital SICU. Clinical and economic outcomes from the study period were compared to a seasonally matched, 16-week time period from the previous year (control). During the control period, a board certified Intensivist was available for daily rounds in the SICU. During both periods, surgical residents were available to the SICU 24 hours a day, but had additional clinical responsibilities. Primary endpoints were ICU and hospital mortality. APACHE III-predicted outcomes corrected for possible differences in severity of illness. Secondary endpoints included LOS and costs. Data collection and analysis were performed by the Johns Hopkins Program for Medical Technology and Practice Assessment. Risk-adjusted outcomes were compared using ANOVA. Results: There were no demographic differences between randomly selected control and study patients (n = 223 and 201, respectively). A 66% reduction in APACHE III-adjusted ICU mortality was realized along with a reduced ICU LOS and hospital mortality. A 41% reduction in ICU profees and a 21% reduction in total ICU costs were also seen. Control Study Legend ICU mortality (O:E) 1.75 0.56*+ O:E = observed:expected ICU LOS (O:E) 0.96 0.86*+ p < .05 Hospital mortality (O:E) 1.07 0.71*+*= compared to predicted Hospital LOS (O:E) 0.63*0.60*+ = between groups ICU profees 3.194 1.883+ study costs include ICU hospital costs 11.265 9.572 equipment and Intensivist ICU total costs 14.459 11.455+ profees Conclusions: Remote ICU care by Intensivists can be used to achieve improved clinical outcomes. The combination of reduced mortality and reduced ICU LOS and costs suggest that these improved clinical outcomes were achieved by reducing adverse events.