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March 28, 2011

Impact of Telemedicine Intensive Care Unit Coverage on Patient Outcomes: A Systematic Review and Meta-analysis

Author Affiliations

Author Affiliations: Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center (Drs Young and Cram), and Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (Ms Lu and Dr Cram); Department of Internal Medicine, Mid America Heart Institute at St Luke's Hospital, University of Missouri, Kansas City (Dr Chan); Division of Cardiology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor (Dr Nallamothu); and Department of Emergency Medicine, University of Colorado, Aurora (Dr Sasson).

Arch Intern Med. 2011;171(6):498-506. doi:10.1001/archinternmed.2011.61

Background  Although remote intensive care unit (ICU) coverage is rapidly being adopted to enhance access to intensivists, its effect on patient outcomes is unclear. We conducted a meta-analysis to examine the impact of telemedicine ICU (tele-ICU) coverage on mortality and length of stay (LOS).

Methods  We conducted a systematic review of studies published from January 1, 1950, through September 30, 2010, using PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science, the Cochrane Library, and conference abstracts. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or on the secondary outcomes of ICU and hospital LOS.

Results  We identified 13 eligible studies involving 35 ICUs. All the studies used a before-and-after design. The studies included 41 374 patients (15 667 pre–tele-ICU and 25 707 post–tele-ICU patients). Tele-ICU coverage was associated with a reduction in ICU mortality (pooled odds ratio, 0.80; 95% confidence interval [CI], 0.66-0.97; P = .02) but not in-hospital mortality for patients admitted to an ICU (pooled odds ratio, 0.82; 95% CI, 0.65-1.03; P = .08). Similarly, tele-ICU coverage was associated with a reduction in ICU LOS (mean difference, −1.26 days; 95% CI, −2.21 to −0.30; P = .01) but not hospital LOS (mean difference, −0.64; 95% CI, −1.52 to 0.25; P = .16).

Conclusion  Tele-ICU coverage is associated with lower ICU mortality and LOS but not with lower in-hospital mortality or hospital LOS.