Original Research: Critical Care |

A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical CareICU Telemedicine Trial

Craig M. Lilly, MD, FCCP; John M. McLaughlin, PhD, MSPH; Huifang Zhao, PhD; Stephen P. Baker, MScPH; Shawn Cody, RN, MSN, MBA; Richard S. Irwin, MD, Master FCCP; for the UMass Memorial Critical Care Operations Group
Author and Funding Information

From the Departments of Medicine (Drs Lilly and Irwin), Anesthesiology (Dr Lilly), Surgery (Dr Lilly), Quantitative Sciences (Mr Baker), and Cell Biology (Mr Baker), the Clinical and Population Health Research Program (Drs Lilly and Zhao), and Graduate School of Biomedical Sciences (Drs Lilly and Zhao and Mr Baker), University of Massachusetts Medical School, Worcester, MA; M.O.R.E. Data Analytics, LLC (Dr McLaughlin), Columbus, OH; the Graduate School of Nursing Sciences (Mr Cody), UMass Memorial Medical Center (Drs Lilly and Irwin and Mr Cody), Worcester, MA.

Correspondence to: Craig M. Lilly, MD, University of Massachusetts Medical School, UMass Memorial Medical Center, 281 Lincoln St, Worcester, MA 01605; e-mail: craig.lilly@umassmed.edu

* A complete list of group members is located in e-Appendix 1.

Funding/Support: Support of this study was provided by the University of Massachusetts Medical School.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;145(3):500-507. doi:10.1378/chest.13-1973
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Background:  Few studies have evaluated both the overall effect of ICU telemedicine programs and the effect of individual components of the intervention on clinical outcomes.

Methods:  The effects of nonrandomized ICU telemedicine interventions on crude and adjusted mortality and length of stay (LOS) were measured. Additionally, individual intervention components related to process and setting of care were evaluated for their association with mortality and LOS.

Results:  Overall, 118,990 adult patients (11,558 control subjects, 107,432 intervention group patients) from 56 ICUs in 32 hospitals from 19 US health-care systems were included. After statistical adjustment, hospital (hazard ratio [HR] = 0.84; 95% CI, 0.78-0.89; P < .001) and ICU (HR = 0.74; 95% CI, 0.68-0.79; P < .001) mortality in the ICU telemedicine intervention group was significantly better than that of control subjects. Moreover, adjusted hospital LOS was reduced, on average, by 0.5 (95% CI, 0.4-0.5), 1.0 (95% CI, 0.7-1.3), and 3.6 (95% CI, 2.3-4.8) days, and adjusted ICU LOS was reduced by 1.1 (95% CI, 0.8-1.4), 2.5 (95% CI, 1.6-3.4), and 4.5 (95% CI, 1.5-7.2) days among those who stayed in the ICU for ≥ 7, ≥ 14, and ≥ 30 days, respectively. Individual components of the interventions that were associated with lower mortality, reduced LOS, or both included (1) intensivist case review within 1 h of admission, (2) timely use of performance data, (3) adherence to ICU best practices, and (4) quicker alert response times.

Conclusions:  ICU telemedicine interventions, specifically interventions that increase early intensivist case involvement, improve adherence to ICU best practices, reduce response times to alarms, and encourage the use of performance data, were associated with lower mortality and LOS.

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