Researchers at the University of Massachusetts Medical School (UMMS; Worcester, USA) conducted a prospective pre- and post-study of 6,290 adults admitted to any of 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on two campuses of an academic medical center from April 2005 through September 2007. Electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms were evaluated. The main outcome measures were case-mix and severity-adjusted hospital mortality; other outcomes included hospital and ICU length of stay, best practice adherence, and complication rates.

The results showed that the hospital mortality rate was 13.6% during the preintervention period, and 11.8% during the tele-ICU period. The tele-ICU intervention period was also associated with higher rates of best clinical practice adherence for cardiovascular protection and prevention of deep vein thrombosis (DVT), stress ulcers, and ventilator-associated pneumonia (VAP), resulting in lower rates of preventable complications. Patients in the tele-ICU period had shorter hospital lengths of stay (9.8 versus 13.3 days), and the results were comparable for medical, surgical, and cardiovascular ICUs.

"It's a very, very, strong clear signal that tele-ICU technology works. Places that are giving pretty good critical care can produce even better critical care with it,” said lead author Craig Lilly, MD, director of the Tele-ICU program at UMMS. “The system leverages technology as well as clinical expertise to provide expert care at 3 am. The problem is, you just can't be there 24/7 because you've got to sleep, and you've got a family.”

The off-site tele-ICU team, which included an intensivist, had the ability to communicate with bedside clinicians or directly manage patients by recording clinician orders for tests, treatments, consultations, and management of life-support devices. Among the responsibilities of the team were reviewing the care of individual patients; performing real-time audits of best practice adherence; monitoring system-generated electronic alerts; auditing bedside clinician responses to in-room alarms; and intervening when the responses of bedside clinicians were delayed and patients were deemed physiologically unstable.

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