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Abstract

Introduction: The evolution of telemedicine in the last decade has influenced not only the ICU metrics of mortality and LOS but also the quality of care through implementation of standardized processes which impacts patients outcome in the ICU. Methods: This is a pre/post retrospective study designed to identify the effect of tele-ICU interventions to improved outcomes of patients in a large multicenter medical, surgical and cardiovascular ICU. We compared outcomes of a random sample of patients from the year Jan 2009-Dec 2009 (Pre-implementation) to outcomes in patients from April 2010-September 2010 (Post- implementation) of tele-ICU. The patients were categorized on the basis of predictive modeling algorithms using APACHE® IV (Cerner, Kansan City, MO) scores. They were categorized as: Low predicted risk (with <10% mortality), Medium predicted risk (10-50% mortality), and High predicted risk (with >50% mortality) The primary outcome are ICU and hospital mortality and number of ventilator days in both the arms. The secondary outcome are ICU and hospital LOS and the influence of implementation of processes on optimization of critical care by using VAP bundle adherence, VAP rates, DVT prophylaxis and SUP prophylaxis. Data are compared between the pre- and post-implementation groups using the Pearson Chi-square and Wilcoxon Ranksum tests as appropriate. The pre-implementation period was then compared with 2013 data of patients from Jan 2013 to June 2013 (Group C) to assess for sustainability of the tele-ICU interventions. Results: We had a total of 187 patients in the pre-implementation arm (Group A) and 2001 in the post-implementation arm (Group B) in our different ICUs-Unit A, B and C. Pre-implementation data for 2009 shows unit mortality at 15.5%, unit B at 13.6%, and unit C at 5.4%. Post-implementation shows unit A at 12.4% in Q2 and 11% in Q3, unit B at 12.4% in Q2 and 12.7% in Q3, and unit C at 2.2% for Q2 and 1.8% for Q3. The ICU LOS was 5.16 days in the Group A and 4.33 days in Q2 and 4.88 days in Q3. There was also a decrease in hospital mortality, and improvement in ICU LOS. We also found in 2013 data (Group C patients) after 3 years of tele-ICU interventions showed a significant improvement in the ICU mortality, ICU LOS and ICU quality metrics. Conclusions: These data supported our hypothesis that the mortality rates were reduced significantly post-implementation. Implementation of tele-ICU (even though an expensive model and proposition with initial high investment and involving changes in the basic infrastructure of an ICU) does influence outcomes of patients, improves hospital quality metrics and advancement of society at large.