Telemedicine Reduces Inter-Hospital ICU Transfers

Telemedicine is associated with a decrease in inter-hospital intensive care unit (ICU) transfer of critically ill patients, according to a new study.

Researchers at Iowa City Veterans Affairs (VA) Health Care System (IA, USA), the University of Iowa (Iowa City, USA), and other institutions conducted a study to test a hypothesis that ICU telemedicine decreases ICU patient inter-hospital transfers. Data were retrieved for patients admitted to 306 VA ICUs between 2011 and 2015. Telemedicine services were provided to 52 ICUs by two support centers, located in Minneapolis (MN, USA) and Cincinnati (OH, USA). In all, there were 553,523 admissions to the VA ICUs, of which 97,256 were to telemedicine hospitals, and 456,267 to non-telemedicine hospitals.

The results revealed that transfers decreased from 3.46% to 1.99% in the telemedicine hospitals, and from 2.03% to 1.68% in the non-telemedicine facilities when comparing pre- and post-telemedicine implementation periods. After adjusting for demographics, illness severity, admission diagnosis, and facility, ICU telemedicine was associated with a relative risk (RR) of 0.79. The highest impact reduction was seen in patients admitted with gastrointestinal (GI) and respiratory admission diagnoses. ICU telemedicine was not associated with an increase in 30-day mortality. The study was published in the July 2018 issue of Chest.

“The effect of telemedicine on transfers was more prominent in patients that do not require any high-resource intervention; for example, patients with status asthmaticus on mechanical ventilator are very challenging for non-critical care trained physicians, although they do not require any invasive procedure,” said lead author Spyridon Fortis, MD, of Iowa City VA Health Care System. “An intensivist with the help of a bedside respiratory therapist can manage these patients remotely by watching the ventilator monitors.”

Telemedicine is essentially a product of modern telecommunication and information technologies that permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging, and health informatics data from one site to another. It is most often used to improve patient, doctor, and nursing staff access to medical services in distant or sparsely populated rural communities.

Related Links:
Iowa City Veterans Affairs Health Care System
University of Iowa