Research shows that intensive care patients have a lower risk of death and shorter lengths of stay when critical care-certified intensivist physicians are on duty and oversee patient care. But a shortage of intensivists makes it difficult for many hospitals to go this route.
A potential solution is linking with an intensivist-staffed tele-ICU. Here, too, obstacles exist. Among them are costs, unproven return on investment and a dearth of outcomes data. A 2010 report by the Massachusetts Technology Collaborative and the New England Healthcare Institute concludes that a well-constructed tele-ICU program not only provides the sought-after intensivist coverage, but also improves outcomes, shortens lengths of stay and reduces costs.
The report details a demonstration project, begun in 2008, in which the University of Massachusetts Memorial Medical Center installed a tele-ICU command center, which covers its seven adult ICUs and those of two outlying community hospitals.
The project's goals were a 10 percent reduction in severity-adjusted ICU mortality rates and a 12-hour decrease in average ICU lengths of stay. The results:
- ICU mortality declined 20 percent and hospital mortality dropped 13 percent at the medical center.
- Severity-adjusted mortality fell by 36 percent at one community hospital but increased at the other, although it remained slightly lower than the expected rate.
- The average ICU length of stay dropped 1.9 days (30 percent) at the medical center.
- Average severity-adjusted ICU LOS dropped by 42 percent at one community hospital and by 16 percent at the other.
- All three hospitals recovered their tele-ICU costs within about one year.
Source: "Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care," Massachusetts Technology Collaborative and New England Healthcare Institute, Dec. 1, 2010