eICU program favorably affects clinical and economic outcomes.

Expanded AbstractCitationBreslow MJ, Rosenfeld BA, Doerfler M, Burke G, Yates G, Stone DJ, Tomaszewicz P, Hochman R, Plocher DW: Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing. Crit Care Med 2004, 32:31–38 1.BackgroundTelemedicine for the intensive care unit (ICU) has been proposed as potential means of leveraging clinical expertise and bringing that expertise to hospitals with inadequate or complete lack access to intensive care specialists (intensivists).ObjectiveTo examine whether a supplemental remote intensive care unit care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs.MethodsDesignBefore-and-after trial to assess the effect of adding a supplemental remote ICU telemedicine program.Setting and PatientsTwo adult ICUs in a 650 bed tertiary care teaching hospital, with a total of 2,140 patients receiving ICU care between 1999 and 2001 (n = 1396 before and n = 744 after implementation).InterventionThe remote care program used intensivists and physician extenders to provide supplemental monitoring and management of ICU patients for 19 hrs/day (noon to 7 am) from a centralized, off-site facility (eICU). Supporting software, including electronic data display, physician note- and order-writing applications, and a computer-based decision-support tool, were available both in the ICU and at the remote site. Clinical and economic performance during 6 months of the remote intensivist program was compared with performance before the intervention.OutcomesPrimary clinical outcomes were ICU and hospital mortality and length of stay, while primary economic outcomes were variable cost per case and average per patient hospital revenue.ResultsHospital mortality for ICU patients was lower during the period of remote ICU care (9.4% vs. 12.9%; relative risk, 0.73; 95% confidence interval CI, 0.55–0.95), and ICU length of stay was shorter (3.63 days 95% CI, 3.21–4.04 vs. 4.35 days 95% CI, 3.93–4.78). Lower variable costs per case and higher hospital revenues (from increased case volumes) generated financial benefits in excess of program costs.ConclusionThe addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.