Intensive care unit (ICU) telemedicine was associated with a decrease in interhospital ICU transfers, particularly in patients with severe illness or with gastrointestinal and respiratory admission diagnoses, according to a study published in CHEST.
Inpatient data were gathered from 306 Veterans Affairs ICUs in 117 acute care facilities from the years 2009 to 2015. During the study period, 52 ICUs in 23 acute care facilities received telemedicine from support centers in Minneapolis and Cincinnati. Interhospital transfer rates were compared between telemedicine-affiliated hospitals vs facilities with no telemedicine program, and the association of ICU telemedicine with transfer rates and 30-day mortality was further assessed. Demographic data, diagnosis category, ICU admission type, and illness severity of participants were adjusted in the outcomes analysis. Researchers further compared the magnitude of change in outcomes measured as relative risk.
The study population included 553,523 individuals admitted to Veterans Affairs ICUs: 97,256 to telemedicine-affiliated hospitals and 456,267 to nontelemedicine hospitals. A 1.47% decrease in transfers was observed in telemedicine hospitals (from 3.46% to 1.99%) vs 0.34% in nontelemedicine hospitals (from 2.03% to 1.68%; P <.001). Overall, ICU telemedicine was associated with reduction in transfers with relative risk of 0.79 (95% CI, 0.71-0.87; P <.001), including patients with moderate to high illness severity, nonsurgical patients, and patients with gastrointestinal and respiratory diagnoses. ICU telemedicine did not affect 30-day mortality, suggesting that transfer decline was not associated with improved ICU care in the telemedicine group.
The study investigators suggested that telemedicine implementation provides better critical care for patients in local ICUs and may prevent their transfer to tertiary facilities, particularly in patients with respiratory and gastrointestinal admission diagnoses.
Disclosures: This study was funded by the Veterans Affairs Office of Rural Health and Center for Comprehensive Access & Delivery Research & Evaluation, Department of Veterans Affairs Health Services Research and Development Program.
Fortis S, Sarrazin MV, Beck BF, Panos RJ, Reisinger HS. ICU telemedicine reduces interhospital ICU transfers in the Veterans Health Administration [published online June 15, 2018]. CHEST. doi:10.1016/j chest.2018.04.021