title: Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay.
abstract: BACKGROUND
  Telemedicine technology, which can enable intensivists to simultaneously monitor several intensive care units (ICUs) from an off-site location, is increasingly common, but there is little evidence to support its use.
  
  
  OBJECTIVE
  To assess the association of remote monitoring of ICU patients (ICU telemedicine [tele-ICU]) with mortality, complications, and length of stay (LOS).
  
  
  METHODS
  Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of tele-ICU. The study included 2034 patients in the preintervention period (January 2003 to August 2005) and 2108 patients in the postintervention period (July 2004 to July 2006).
  
  
  METHODS
  Hospital and ICU mortality, complications, and hospital and ICU survivors' LOS, with outcomes adjusted for severity of illness.
  
  
  RESULTS
  Local physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%) and authority to intervene only in life-threatening events for the remainder. Observed hospital mortality rates were 12.0% (95% confidence interval [CI], 10.6% to 13.5%) in the preintervention period and 9.9% (95% CI, 8.6% to 11.2%) in the postintervention period (preintervention to postintervention decrease, 2.1%; 95% CI, 0.2% to 4.1%; P = .03); observed ICU mortality rates were 9.2% (95% CI, 8.0% to 10.5%) in the preintervention period and 7.8% (95% CI, 6.7% to 9.0%) in the postintervention period (preintervention to postintervention decrease, 1.4%; 95% CI, -0.3% to 3.2%; P = .12). After adjustment for severity of illness, there were no significant differences associated with the telemedicine intervention for hospital mortality (relative risk, 0.85; 95% CI, 0.71 to 1.03) or for ICU mortality (relative risk, 0.88; 95% CI, 0.71 to 1.08). There was a significant interaction between the tele-ICU intervention and severity of illness (P < .001), in which tele-ICU was associated with improved survival in sicker patients but with no improvement or worse outcomes in less sick patients. There were no significant differences between the preintervention and postintervention periods for hospital or ICU LOS.
  
  
  CONCLUSIONS
  Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. eric.thomas@uth.tmc.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Lucke
authors.forename: Laura
authors.initials: L
authors.lastname: Wueste
authors.forename: Lisa
authors.initials: L
authors.lastname: Weavind
authors.forename: Bela
authors.initials: B
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality; D036262:Empirical Research; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D017216:Telemedicine; D013686:Telemetry