ICU telemedicine reduces interhospital ICU transfers of critically ill patients

By providing remote access to acute care expertise, local ICUs were able to treat more critically ill patients on site, according to a new study in the journal CHEST®


Glenview, IL, June 15, 2018

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.

“Tele-ICU provides acute care expertise remotely to help local ICUs treat critically ill patients. Our study validates that it prevents transfers to other facilities without increasing the risk of mortality,” explained lead investigator, Spyridon Fortis, MD, Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA. Tele-intensivists collaborate with local staff to co-manage patient care at the bedside, using cameras and sharing vital signs and equipment, and in many cases, preventing the need to triage patients to centers with more enhanced capabilities. “The on-site treatment helps to lower the cost of care and improves patient, family, and staff satisfaction.”

The study tracked 553,523 patients admitted to VA hospital ICUs (97,256 with access to Tele-ICU services, and 456,267 without). Data were 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 percent (from 3.46 percent to 1.99 percent) in the facilities with available Tele-ICU and 0.34 percent (from 2.03 percent to 1.68 percent) 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.

This study was part of a larger analysis of the VA system’s Tele-ICU implementation and outcomes. The current investigation studied a national healthcare system with a large number of ICU patients, although the researchers noted some limitations. For example, transfers prior to ICU admission were excluded, and patients whose care needs may not have been addressed by the available Tele-ICU team were included. The investigators stress that the study’s limitations do not outweigh its strengths, which included a large sample size and the availability of pre-implementation data.

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Notes for editors
The article is “ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration,” by Spyridon Fortis, MD, Mary V. Sarrazin, PhD, Brice F. Beck, MAE, Ralph J. Panos, MD, and Heather S. Reisinger, PhD (https://doi.org/10.1016/j.chest.2018.04.021). It will appear in the journal CHEST®, volume 154, issue 1 (July 2018) published by Elsevier.

This work is supported by the VA Office of Rural Health for ongoing evaluation of the VA Tele-ICU Program and Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Award # CIN-13-412, Department of Veterans Affairs Health Services Research and Development Program. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact the American College of Chest Physicians, Andrea Camino, at +1 224 521 9513, acamino@chestnet.org, or Taylor Pecko-Reid at +1 224 521 9603, tpeckoreid@chestnet.org.

About the journal CHEST®
The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestjournal.org

About American College of Chest Physicians (CHEST)®
CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. Its mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. It serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. For information about the American College of Chest Physicians and its flagship journal CHEST®, visit chestnet.org.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 38,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Andrea Camino
American College of Chest Physicians (CHEST)
+1 224 521 9513
acamino@chestnet.org