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BACKGROUND: The telemedicine intensive care unit (Tele-ICU) is defined as a system in which intensive care professionals remotely provide care to critically ill patients and support the on-site staff in the intensive care unit (ICU) using secured audio-video and electronic links. Although the Tele-ICU is expected to resolve the shortage of intensivists and reduce the regional disparities in intensive care resources, the efficacy has not yet been evaluated in Japan because of a lack of clinically available system. METHODS: This was a single-center, historical comparison study in which the impact of the Tele-ICU on ICU performance and changes in workload of the on-site staff were evaluated. The Tele-ICU system developed in the United States was used. Data for 893 adult ICU patients before the Tele-ICU implementation and for all adult patients registered in the Tele-ICU system from April 2018 to March 2020 were abstracted and included. We investigated ICU and hospital mortality and length of stay and ventilation duration after the Tele-ICU implementation in each ICU, and compared between pre and post implementation and changes over time. We also assessed physician workload as defined by the frequency and duration of access to the electronic medical record (EMR) of the targeted ICU patients. RESULTS: After the Tele-ICU implementation 5438 patients were included. In unadjusted data pre/post study showed significant decreases in ICU (8.5-3.8%) and hospital (12.4-7.7%) mortality and ICU length of stay (p < 0.001), and those values were maintained for 2 years. In data stratified by predicted hospital mortality, ICU and hospital actual mortality in high and medium risk patients decreased significantly after the implementation. Ventilation duration was shortened (p < 0.007). Access frequency of the on-site physicians decreased by 25%, and the decrease occurred in the daytime shift and in the physicians with 3-15 years of work experience. CONCLUSIONS: Our study showed the Tele-ICU implementation was associated with lower mortality, especially in medium and high risk patients, and decreased EMR-related tasks of on-site physicians. These results suggest that the Tele-ICU could be a solution of the shortage of intensivists and regional disparities for intensive care.
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OBJECTIVES: Given the numerous recent changes in ICU practices and protocols, we sought to confirm whether favorable effects of telemedicine ICU interventions on ICU mortality and length of stay can be replicated by a more recent telemedicine ICU intervention. DESIGN SETTING AND PATIENTS: Observational before-after telemedicine ICU intervention study in seven adult ICUs in two hospitals. The study included 1,403 patients in the preintervention period (October 2014 to September 2015) and 14,874 patients in the postintervention period (January 2016 to December 2018). INTERVENTION: Telemedicine ICU implementation. MEASUREMENTS AND MAIN RESULTS: ICU and hospital mortality and length of stay, best practice adherence rates, and telemedicine ICU performance metrics. Unadjusted ICU and hospital mortality and lengths of stay were not statistically significantly different. Adjustment for Acute Physiology and Chronic Health Evaluation Version IVa score, ICU type, and ICU admission time via logistic regression yielded significantly lower ICU and hospital mortality odds ratios of 0.58 (95% CI, 0.45-0.74) and 0.66 (95% CI, 0.54-0.80), respectively. When adjusting for acuity by comparing observed-over-expected length of stay ratios through Acute Physiology and Chronic Health Evaluation IVa methodology, we found significantly lower ICU and hospital length of stay in the postintervention group. ICU mortality improvements were driven by nighttime ICU admissions (odds ratio 0.45 [95% CI, 0.33-0.61]) as compared to daytime ICU admissions (odds ratio 0.81 [95% CI, 0.55-1.20]), whereas hospital mortality improvements were seen in both subgroups but more prominently in nighttime ICU admissions (odds ratio 0.57 [95% CI, 0.44-0.74]) as compared to daytime ICU admissions (odds ratio 0.73 [95% CI, 0.55-0.97]), suggesting that telemedicine ICU intervention can effectively supplement low intensity bedside staffing hours (nighttime). CONCLUSIONS: In this pre-post observational study, telemedicine ICU intervention was associated with improvements in care standardization and decreases in ICU and hospital mortality and length of stay. The mortality benefits were mediated in part through telemedicine ICU supplementation of low intensity bedside staffing hours.
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PURPOSE: We conducted an evaluation to identify factors related to intensive care unit (ICU) staff acceptance of a telemedicine ICU (Tele-ICU) program in preimplementation and postimplementation phases. METHODS: Individual or group semistructured interviews and site observations were conducted with staff from the Veterans Affairs Midwest Health Care Network Tele-ICU and affiliated ICUs. A qualitative content analysis of preimplementation and postimplementation transcripts and field notes was undertaken to identify themes positively and negatively influencing Tele-ICU acceptance. RESULTS: Telemedicine ICU training, Tele-ICU understanding, perceived need, and organizational factors emerged as influencing acceptance of the Tele-ICU before implementation. After implementation, Tele-ICU understanding, impact on work systems, perceived usefulness, and relationships were factors influencing acceptance and utilization. Barriers to implementation included confusion about how to use the Tele-ICU, disruptions to communication and workflows, unmet expectations, and discomfort with being monitored. Facilitators included positive experiences, discovery of new benefits, and recognition of Tele-ICU staff as complementing bedside care. CONCLUSIONS: Telemedicine ICU implementation is complex. Time and resources should be allocated for local coordination, continuous needs assessment for Tele-ICU support, staff training, developing interpersonal relationships, and systems design and evaluation. Such efforts are likely to be rewarded with more rapid staff acceptance of this new technology.