PURPOSE:Improving Intensive Care Unit (ICU) outcomes and reducing costs in an era of intensivist shortage is challenging. Remote telemonitoring in ICU care is emerging as an alternative to providing on-site 24-hour intensivist coverage. Our institution implemented a remote telemonitoring system for intensive care units in 2005. We wished to evaluate the impact of this program in terms of patient outcomes.
METHODS:A before-and-after comparison of outcomes 1 year prior to remote telemonitoring implementation to two years after implementation in three tertiary hospital ICUs. We evaluated severity-adjusted ICU and hospital length of stay (LOS) and ICU and Hospital Mortality. APACHE® III methodology was used for severity adjustment. ANOVA and Logistic regression were used to conduct analyses.
RESULTS:Data were available on 700 patients in 2004 (pre), and 1672 patients in 2006, and 2920 patients in 2007 (post). Severity-adjusted ICU LOS improved from 0.84 in 2004 to 0.56 in 2006 to -0.03 in 2007 (p<0.001). Severity-adjusted hospital length of stay also improved from 0.97 to 0.32 to -0.64 (p=0.001). This LOS reduction translated into 4772 saved ICU days and 6091 saved floor days. Additionally, we found a trend toward improved ICU mortality (p=0.159) and improved hospital mortality (p=0.214).
CONCLUSION:Remote teleintensivist care correlated with an improvement of severity-adjusted ICU and hospital length of stay. There was also a trend toward improved mortality.
CLINICAL IMPLICATIONS:Leveraging one intensivist across multiple ICUs by remote telemonitoring is a safe and effective strategy to provide around-the-clock care in an era of reduced intensivist supply. LOS reductions can reduce costs and increase throughput.
DISCLOSURE:Thomas Ardilles, Other Assistance with data abstraction provided by VISICU; No Product/Research Disclosure Information