CARING FOR THE CRITICALLY ILL PATIENT AssociationofTelemedicineforRemoteMonitoring of Intensive Care Patients With Mortality, Complications, and Length of Stay

CARE PROVIDED IN INTENSIVE care units (ICUs) is notable for its high cost and high rates of morbidity and mortality. Because onsite staffing by intensivists has been associated with lower morbidity and mortality, experts recommend that intensivists care for ICU patients. However, there is a shortage of intensivists, which has led to the use of telemedicine technology to allow intensivists to remotely and simultaneously care for patients in several ICUs (ICU telemedicine [teleICU]), thus extending their reach. Remote monitoring may be a partial solution for the intensivist shortage, but it is expensive, its use is increasing, and there are few data in the peer-reviewed literature evaluating its effect on morbidity and mortality. Furthermore, it is not known whether remote monitoring by intensivists would benefit all or only a subset of ICU patients. Therefore, we conducted this study to assess the effect of a tele-ICU intervention on mortality, complications, and length of stay in 6 ICUs in a large health care system by measuring these outcomes before and after implementation of the tele-ICU. METHODS Setting We studied the use of a tele-ICU intervention in a large, nonprofit health care system located in the Gulf Coast region of the United States. The teleICU was implemented to care for all patients in 7 ICUs (one of these, a neurotrauma ICU, was not included in this study). When describing the ICUs, we use the term “closed” to indicate units in which intensivists were the only phy-