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Implementation of telemedicine in VA ICUs may not reduce death rates or length of hospital stays


A VA study found only modest added benefits from a telemedicine program that features a telemonitoring center.
A VA study found only modest added benefits from a telemedicine program that features a telemonitoring center. (Photo: © iStock/Donghero)

A VA study found only modest added benefits from a telemedicine program that features a telemonitoring center. (Photo: © iStock/Donghero)

Intensive care unit (ICU) telemedicine has been promoted as a way to improve access to intensive care specialists, and thereby improve patient outcomes. However, a recent study led by Dr. Boulos S. Nassar of the Iowa City VA Health Care System found that an ICU telemedicine program at eight VA hospitals did not change patient outcomes.

The system looked at in this study featured a telemonitoring center that was staffed nearly 24/7 with an experienced "intensivist" and two critical care nurses. The center had real-time access to patient vital signs, intravenous infusion rates, and ventilator settings. There were also high-speed video and audio connections between all ICU patient rooms and the monitoring center.

The study included Veterans treated between 2011 and 2012 in facilities that had implemented the telemedicine program in their ICUs, as well as Veterans treated in facilities without the program.

In all, the study included 1,647 patients who had been treated in ICUs with telemedicine monitoring; 1,708 patients who were treated in the same ICUs before the monitoring was implemented, and 3,585 patients treated in ICUs that did not use telemedicine monitoring at all.

"We found no evidence that implementation of ICU telemedicine significantly reduced mortality rates or length of stay," Nassar told Clinical Innovation and Technology magazine.

Mortality (death) rates were modestly lower for admissions to the facilities with telemedicine monitoring, both before and after the monitoring program was implemented. However, the implementation of telemedicine was not associated with a significant decline in ICU or in-hospital deaths within 30 days of admission. Nor did the program lead to a reduction in the length of patients' stays in the hospital.

A previous study by a non-VA research team had suggested that ICU telemedicine could help reduce the cost of ICU care, patient mortality, length of stay, and other parameters. The new study appears to show otherwise. In their article, Dr. Nassar and his team analyze various factors that could explain the varying research results, and offer suggestions for optimizing telemedicine in ICUs. (JAMA Internal Medicine, July 2014)


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