Tele-ICU Can Reduce Mortality and Length of Stay

Multiple commercial applications of ICU telemedicine now exist, and telemedicine is widely touted as an all-encompassing strategy to improve ICU outcomes. Yet even after 25 years, the optimal role of telemedicine in the ICU remains uncertain. Several previous studies have not demonstrated a benefit. The difference with the telemedicine program in this study is that it was tightly linked to specific quality improvement activities. For this reason, the study by Dr. Lilly and colleagues provides the first convincing evidence that ICU telemedicine can be an effective complement to bedside care in some settings.

The seven ICUs in this study, however, are part of one relatively well-resourced academic medical center that has a strong culture of quality improvement. It is unclear if these results could be replicated in hospitals with fewer resources to devote toward ICU quality. Moreover, all of the telemedicine physicians also worked in the target ICUs, which may have served to increase buy-in among local practitioners. These results may not translate to settings in which the telemedicine unit and hospital unit do not share physicians.

In the right settings and with the right goals, telemedicine can indeed be used to help improve outcomes. Yet, just as with all applications of health information technology, good outcomes should not be assumed. The challenge is to not conclude from this study that ICU telemedicine always is associated with improved quality of care, but instead to continue to explore how telemedicine can be used in clinical settings in which other strategies for quality improvement have not worked. Only then will it be possible to improve the use and avoid the misuse of this complex and evolving technology.

Dr. Jeremy M. Kahn is with the department of critical care medicine and the department of health policy and management at the University of Pittsburgh.