title: Remote care by telemedicine in the ICU:  many models of care can be effective.
abstract: OBJECTIVE
  Telemedicine, by the use of audiovisual technologies, is increasingly being used to assist in patient care by ICUs unable to be staffed by consultant intensivists. This review discusses the recent evaluation of these services and their potential role in managing intensive care patients.
  
  
  RESULTS
  Models of care range from complete remote 24 h surveillance requiring direct video observation to a consultation liaison service only requiring conventional telephone links. There has been a rapid adoption of such services especially in North America where access to on-site intensive care specialists is limited for the volume of intensive care being undertaken. Early work suggests savings in terms of cost and length of stay with an improvement in compliance with care protocols. However, later work is not as supportive of such services, possibly related to differing care infrastructures and the organization of individual units. The key task is to ascertain the most appropriate service requirements that would assist in care for a given patient circumstance.
  
  
  CONCLUSIONS
  Clear benefits of ICU-telemedicine systems remain unclear but at least the systems appear safe. Formal reviews of the impacts and contribution of ICU telemedicine to processes of care, the effects on unit staffing, hospital organization, and the healthcare region are needed. However, ICU-telemedicine is available and being embraced by some, especially to deal with the tyranny of distance.
authors: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Rob_Boots@health.qld.gov.au
authors: Robert James
authors: RJ
authors: Boots
authors: Sunil
authors: S
authors: Singh
authors: Morne
authors: M
authors: Terblanche
authors: Neil
authors: N
authors: Widdicombe
authors: Jeffery
authors: J
authors: Lipman
mesh_terms: D016638:Critical Illness; D006301:Health Services Needs and Demand; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D017146:Models, Organizational; D005791:Patient Care; D010348:Patient Care Team; D011793:Queensland; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*