Review: Cohort studies (no RCTs) show that tele-ICU implementation is linked to reduced ICU mortality.
Fusaro MV, Becker C, Scurlock C Evaluating Tele-ICU Implementation Based on Observed and Predicted ICU Mortality: A Systematic Review and Meta-Analysis. Crit Care Med. 2019 Apr;47(4):501-507. doi: 10.1097/CCM.0000000000003627.

OBJECTIVES: Past studies have examined numerous components of tele-ICU care to decipher which elements increase patient and institutional benefit. These factors include review of the patient chart within 1 hour, frequent collaborative data reviews, mechanisms for rapid laboratory/alert review, and interdisciplinary rounds. Previous meta-analyses have found an overall ICU mortality benefit implementing tele-ICU, however, subgroup analyses found few differences. The purpose of this systematic review and meta-analysis was to explore the effect of tele-ICU implementation with regard to ICU mortality and explore subgroup differences via observed and predicted mortality.

DATA SOURCES: We searched PubMed, Cochrane Library, Embase, and European Society of Intensive Care Medicine for articles related to tele-ICU from inception to September 18, 2018.

STUDY SELECTION: We included all trials meeting inclusion criteria which looked at the effect of tele-ICU implementation on ICU mortality.

DATA EXTRACTION: We abstracted study characteristics, patient characteristics, severity of illness scores, and ICU mortality rates.

DATA SYNTHESIS: We included 13 studies from 2,766 abstracts identified from our search strategy. The before-after tele-ICU implementation pooled odds ratio for overall ICU mortality was 0.75 (95% CI, 0.65-0.88; p < 0.001). In subgroup analysis, the pooled odds ratio for ICU mortality between the greater than 1 versus less than 1 observed to predicted mortality ratios was 0.64 (95% CI, 0.52-0.77; p < 0.001) and 0.98 (95% CI, 0.81-1.18; p = 0.81), respectively. Test for interaction was significant (p = 0.002).

CONCLUSIONS: After evaluating all included studies, tele-ICU implementation was associated with an overall reduction in ICU mortality. Subgroup analysis suggests that publications exhibiting observed to predicted ICU mortality ratios of greater than 1 before tele-ICU implementation was associated with a reduction in ICU mortality after tele-ICU implementation. No significant ICU mortality reduction was noted in the subgroup of observed to predicted ICU mortality ratio less than 1 before tele-ICU implementation. Future studies should confirm this finding using patient-level data.

Show me more articles about:
Quality Care
Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Comments from MORE raters

Intensivist/Critical Care

With the movements to virtual delivery of assessment and decision-making of care within hospitals and beyond, this data provides some objective evidence of effectiveness that encourages broader evaluation of this technology.

Comments from JournalWise subscribers

No subscriber has commented on this article yet.