Telehealth Improves Patient Care in ICUs

Patient survival of ICUs is 26% more likely when backed by eICU services, and patients are discharged faster from the ICU and the hospital, a new study finds.

New research supports telehealth within intensive care units as improving patient survival rates and speeding discharge.

"A Multi-center Study of ICU Telemedicine Reengineering of Adult Critical Care" examined the impact of remote intensive care units (eICUs) on nearly 120,000 critical care patients who were treated at 56 intensive care units, 32 hospitals, and 19 health systems over a five-year period. The research demonstrated reductions in both mortality and length of stay. The results were statistically significant on both an unadjusted and severity-adjusted basis.

The study, which was published Thursday in CHEST Journal Online First, was authored by Craig M. Lilly, MD, professor of medicine, anesthesiology, and surgery at the University of Massachusetts Medical School and Director of the eICU Program at UMass Memorial Medical Center in Worcester, MA.

"The number one thing was that either your care plan was created by an intensive care specialist [working remotely], or within one hour of you arriving at the ICU, an intensive care specialist went over the plan and made sure it was right, almost like a second opinion if you will," Lilly told HealthLeaders Media. "These [eICU] systems generate an awful lot of information about performance, and folks that use that information in nearly real time to improve their performance, to understand what they were doing, and how to do it better, had a lot greater improvement than people that reviewed it quarterly or annually or [only] when they had a problem."

Participants were drawn from 19 healthcare systems participating in Philips Healthcare's eICU program. The eICU program is a technology and clinical reengineering program that enables physicians and other healthcare workers at a centralized eICU center to provide around-the-clock care for critically ill patients. The eICU program utilizes bidirectional audio/video technology, population management tools, clinical decision support, real-time and retrospective reporting tools, and targeted process redesign.

The key findings of the study were that, compared to patients receiving standard ICU care, patients who received their ICU care from a hospital that utilized the eICU program were:

• 26% more likely to survive the ICU
• Discharged from the ICU 20% faster
• 16% more likely to survive hospitalization and be discharged
• Discharged from the hospital 15% faster

Also important was whether clinicians responded to alerts and alarms within three minutes, Lilly says. "The bedside people do it just fine most of the time," Lilly says. "But occasionally they're busy and diverted and they're not paying attention as they need to. The offsite team can help to make that happen, and that decision support piece was important."

Another key element: using telemedicine to enable multidisciplinary rounds to help busy doctors and nurses talk to each other at the right times, Lilly says. "That ability to communicate with one another and do decision-making in a multidisciplinary way is also a form of decision support," he adds.

When asked if telemedicine alone would have the same benefits as adding decision support, Lilly says "the more of those things you did, the better you got."

While a paper and pencil is still better than nothing in clinical care, "having an offsite team that double-checks to make sure that the order's right, that the nurse is doing it right, and that the patient actually got what they needed to get, makes a difference," Lilly says.

The American College of Chest Physicians, which publishes CHEST Journal Online First, consists predominantly of pulmonologists and pulmonary care doctors, thoracic surgeons, anesthesiologists, and cardiologists. Philips officials say their eICU product currently supports approximately 12% to 13% of all adult ICU beds in the United States.