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October 5, 2011

Evaluating Tele-ICU Reengineering of Critical Care Processes—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Medicine, University of Massachusetts Medical School, Worcester (

JAMA. 2011;306(13):1441-1442. doi:10.1001/jama.2011.1401

In Reply: As Dr Metske and colleagues imply, the association of reengineering with better outcomes is not automatic; rather it depends on the ability of the intervention to change processes and behaviors. The measures that were available in our ICU telemedicine study allowed us to identify process-of-care changes to which part of the lower mortality and shorter length of stay that we observed could be attributed. The study identified higher levels of adherence to prospectively identified critical care best practices, more robust intensivist review for off-hours ICU admissions, and new methods for detecting and responding to alerts and alarms of evolving physiological instability. Processes of care that were altered by tele-ICU enabled critical care reengineering and were associated with better outcomes.