Overnight Telemedicine Services Reduce Mortality in ICU Patients

By CHRISTINA FRANGOU

Patients in the ICU who received telemedicine services overnight were less likely to die, and were more likely to be discharged quicker than patients receiving traditional ICU care with no on-site intensivist overnight, according to a study presented at the 2021 Critical Care Congress Virtual Event.

The retrospective study ended just before the COVID-19 pandemic began, but the results underscore the value of ICU telemedicine at a time when critical care specialists are in short supply, according to the investigators.

“In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” said Chiedozie I. Udeh, MD, a critical care anesthesiologist at the Cleveland Clinic Foundation and lead author of the study.

Dr. Udeh and his colleagues reviewed the cases of 153,987 patients who received ICU care at one of nine Cleveland Clinic hospitals between Jan. 1, 2010, and Dec. 31, 2019. Overall, 70% of ICU patients (108,482) received telemedicine care when an intensivist wasn’t on-site between 7 p.m. and 7 a.m. An offsite team of intensivists, acute care nurse practitioners and critical care nurses monitored and assessed patients remotely.

Analysis showed that ICU patients who received telemedicine care were about 18% less likely to die, and spent 1.6 fewer days in the ICU and 2.1 fewer days in the hospital. In this study, researchers found that patients who were admitted on a weekend were no more likely to die than those who were admitted on a weekday, despite weekend admission being a known risk factor for death in an ICU.

“Telemedicine offers an excellent means for providing a high level of care, allowing health issues to be discovered earlier and care moved along more quickly so that recovery can be as smooth and as swift as possible,” Dr. Udeh said.

Today, about 15% to 20% of hospitals throughout the United States offer ICU telemedicine through an off-site command center. In some cases, ICU telemedicine is provided by an independent company or a different hospital system.

From the telemedicine command center, tele-intensivists monitor a dashboard of patients at distant hospitals. Using realtime audiovisual two-way communication, the intensivist can see and speak to the bedside nurse and patient, and can observe various monitors tracking patients’ vitals. They can also call up medical records, x-rays and other test results.

The software often includes decision support tools to help identify patients who may be sicker or are deteriorating.

ICU medicine is particularly well suited to telemedicine because it’s physiologically based rather than requiring substantial hands-on provider–patient interaction, said Omar Danner, MD, an adjunct professor of surgery and the former chief of surgery at Grady Memorial Hospital for the Morehouse School of Medicine, in Atlanta.

“It’s very plausible with critical care that you can access 95% to 99% of the information you need remotely and can guide

the person who is at the bedside,” he said. As such, he was not surprised by the positive results reported in this study.

Other studies are underway that examine outcomes for ICU patients with COVID-19 who received ICU telemedicine. Dr. Danner expects the studies will also show a benefit for telemedicine, including a reduction in nosocomial infection rates. Telemedicine means fewer people are required to be in the room with patients with highly contagious infection.

“The COVID-19 pandemic has challenged systems and now allowed us to also test telemedicine in the ICU. Telemedicine does have its place,” he said. ■

Analysis showed that ICU patients who received telemedicine care were about 18% less likely to die, and spent 1.6 fewer days in the ICU and 2.1 fewer days in the hospital.