Only a minority of intensive care units (ICUs) in smaller, community, and regional ICUs in the United States hire intensivists to provide advanced critical care, but many employ ICU telemedicine (Tele-ICU) to help fill the gap. The Veteran’s Administration (VA) has implemented a Tele-ICU program to provide remote access to comprehensive acute care expertise for smaller, community, and regional ICUs in its health system.
A new study in the journal Chest examined transfers of ICU patients to acute care centers before and after the VA implemented its Tele-ICU program. Investigators found that hospitals using Tele-ICU support experienced a greater reduction in transfers of ICU patients to other facilities than hospitals that did not use the services. Additionally, mortality did not change when more patients were treated locally through Tele-ICU.
The study tracked 553,523 patients admitted to VA hospital ICUs (97,256 with access to Tele-ICU services, and 456,267 without). Data was retrieved for all patients admitted to 306 VA ICUs in 117 acute care facilities from October 2009 through September 2015, excluding those for whom vital data were missing. During this period, the VA implemented Tele-ICU at 52 ICUs in 23 facilities in nine states.
Overall, interhospital transfers decreased by 1.47% (from 3.46% to 1.99%) in the facilities with available Tele-ICU and 0.34% (from 2.03% to 1.68%) in facilities without the services, between pre- and post-implementation periods. After adjusting for demographics, illness severity, admission diagnosis, and facility, Tele-ICU was associated with overall reduced transfers; the reduction occurred in patients with moderate, moderate-to-high, and high illness severity and in nonsurgical patients.
The findings were not affected by the day of admission or ICU patient volume levels. The decrease in transfers was seen in all patient groups except those presenting with mild illness severity. Tele-ICU did not change overall adjusted or unadjusted 30-day mortality.
