Tele-ICU Program Reduces Transfers of VA’s ICU Patients

by U.S. Medicine

August 3, 2018

IOWA CITY, IA — Most intensive care units (ICUs) in smaller, community, and regional hospitals aren’t able to support intensivist staffs to provide advanced critical care. Some of those use Tele-ICU instead to provide patients with a higher level of care.

One of the largest users of the technology is the VA, which has implemented Tele-ICU programs to provide remote access to comprehensive acute care expertise for smaller, community, and regional ICUs in its health system.

A new study in the journal CHEST looked at transfers of ICU patients to acute care centers before and after the VA implemented its telehealth program.1

Researchers from the Comprehensive Access & Delivery Research & Evaluation (CADRE) at the Iowa City, IA, VA Health Care System and colleagues determined that hospitals using Tele-ICU system had fewer transfers of ICU patients to other facilities than hospitals that did not use the services. At the same time, no increase in mortality was detected when more patients were treated locally through Tele-ICU.

“Tele-ICU provides acute care expertise remotely to help local ICUs treat critically ill patients. Our study validates that it prevents transfers to other facilities without increasing the risk of mortality,” explained lead investigator, Spyridon Fortis, MD, who also is in the Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine.

Fortis noted that remote intensivists can collaborate with local staff to co-manage patient care at the bedside, using cameras and sharing vital signs and equipment. That can reduce the need to triage patients to centers with more enhanced capabilities, he pointed out, adding, “The on-site treatment helps to lower the cost of care and improves patient, family, and staff satisfaction.”

Included in the study were 553,523 patients admitted to VA hospital ICUs — 97,256 with access to Tele-ICU services, and 456,267 without. Data came from all patients admitted to 306 VA ICUs in 117 acute care facilities from October 2009 through September 2015; during that time, the VA initiated Tele-ICU at 52 ICUs in 23 facilities in nine states.

Results indicated that transfers decreased from 3.46% to 1.99% in the telemedicine hospitals and from 2.03% to 1.68% in the non-telemedicine facilities between pre- and post-telemedicine implementation periods.

After adjusting for demographics, illness severity, admission diagnosis, and facility, the study team reported that ICU telemedicine was associated with overall reduced transfers with a relative risk (RR) of 0.79 (95% CI, 0.71-0.87; P < .001); this reduction occurred in patients with moderate (RR, 0.77; 95% CI, 0.61-0.98; P =.034), moderate to high (RR, 0.79; 95% CI, 0.63-0.98; P =.035), and high illness severity (RR, 0.73; 95% CI, 0.60-0.90; P =.003) and in nonsurgical patients (RR, 0.82; 95% CI, 0.73-0.92; P =.001).

Transfers decreased in patients admitted with gastrointestinal (RR, 0.55; 95% CI, 0.41-0.74, P < .001) and respiratory admission diagnoses (RR, 0.52; 95% CI, 0.38-0.71; P < .001), according to the study, which added that ICU telemedicine was not associated with an increase in 30-day mortality.

The study was part of a larger analysis of the VA system’s Tele-ICU implementation and outcomes.

1. Fortis S, Sarrazin MV, Beck BF, Panos RJ, Reisinger HS. ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration. Chest. 2018 Jun 5. pii: S0012-3692(18)30636-6. doi: 10.1016/j.chest.2018.04.021. [Epub ahead of print] PubMed PMID: 29914751.

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