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Abstract

We thank Drs Taylor and Taylor for their comments on our study1Fortis S. Sarrazin M.V. Beck B.F. et al.ICU telemedicine reduces interhospital ICU transfers in the Veterans Health Administration.Chest. 2018; 154: 69-76Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar and their suggestions regarding further investigation of the effect of telemedicine on critical care outcomes. As they pointed out, ICU telemedicine was associated with increased mortality in the transferred patients. The increased mortality in the transferred patients following telemedicine implementation may reflect that the “less sick” patients were not transferred (the denominator is smaller) while the sickest patients continued to be transferred. We agree that appropriate interhospital transfers are only those that can change the patients’ trajectory. Very sick patients who are unlikely to survive even if they receive care in high-resource facilities should not be transferred for the reasons that Drs Taylor and Taylor described. Nevertheless, family and, often, providers may request transfer of the sickest patients to advanced tertiary centers out of desperation. It is possible that ICUs with fewer resources may not be prepared for end-of-life discussions. Although we have no additional data regarding these futile transfers, a previous report showed that palliative care expertise can be provided to critically ill patients remotely via telemedicine.2Menon P.R. Stapleton R.D. McVeigh U. et al.Telemedicine as a tool to provide family conferences and palliative care consultations in critically ill patients at rural health care institutions: a pilot study.Am J Hosp Palliat Care. 2015; 32: 448-453Crossref PubMed Scopus (27) Google Scholar ICU telemedicine should play a key role in end-of-life discussions supporting bedside staff and family, and preventing unnecessary transfers. Leveraging ICU Telemedicine to Reduce Low-Value Interhospital TransferCHESTVol. 154Issue 4PreviewIn a large study with rigorous methods, Fortis and colleagues1 reported in a recent issue of CHEST (July 2018) that ICU telemedicine was associated with a decreased rate of interhospital transfers among patients in Veterans Affairs ICUs. Although mortality was not the study’s primary outcome, the authors also present the interesting result that ICU telemedicine was associated with increased adjusted 30-day mortality among transferred patients. The authors reasonably suggest that this finding indicates appropriate triage of the most severely ill patients. Full-Text PDF ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health AdministrationCHESTVol. 154Issue 1PreviewThe effect of ICU telemedicine on transfers is not well studied. This study tests the hypothesis that ICU telemedicine decreases ICU patient interhospital transfers. Full-Text PDF