Study Affirms Telemedicine-ICU as a Viable Model of Care

While the concept of ICU telemedicine isn’t new, recent findings suggest that patients who receive these services may have reduced odds of mortality at 30 days and be discharged home sooner than patients who received traditional ICU care. The study results were presented at the Society of Critical Care Medicine’s 50th Critical Care Congress.

Chiedozie I. Udeh MBBS, MHEcon, MBA, lead author of the study, says the research team set out to determine whether or not the virtual model was improving outcomes.

Cleveland Clinic launched its ICU telemedicine program in 2014, and the rollout was completed by 2016 – well before the onset of the COVID-19 pandemic. But these findings underscore the importance of the round-the-clock care of an intensivist, which is simply not feasible in the traditional model, says Dr. Udeh, particularly with the growing shortage of intensivists in the U.S.

The demand for critical care, coupled with the decline in intensivists, in part due to burnout, has made clear the need for a nontraditional approach to maximize resources. The virtual ICU model addresses this clinical need, says Dr. Udeh.

It enables nearly every facet of critical care, including monitoring bedside vitals, reviewing test results and electronic health records and coordinating care with the bedside caregivers. The investigators also aimed to evaluate the cost-efficiency of such programs.

“It’s a worthwhile question from the perspectives of both care and economy,” says Dr. Udeh. “Right from the beginning, there was no reimbursement for ICU telemedicine. Hospitals are paying for this. It’s important to assess the return on investment,” he says.

Dr. Udeh and team retrospectively examined patients (N = 153,987) who received care at one of nine Cleveland Clinic hospitals over ten years (January 1, 2010, to December 31, 2019). The investigation shows that 70% (N = 108,482) received care via ICU telemedicine during hours when an intensivist was not physically present. After controlling for variables, the data revealed that patients in the virtual ICU cohort were about 18% less likely to die, spent 1.6 fewer days in the ICU, and 2.1 fewer days in the hospital.

Other studies have investigated the utility of a virtual ICU model, but few were powered to examine the research question at a scale this large, over such a long period. Most of the earlier studies, Dr. Udeh says, looked at shorter time intervals. Many didn’t have robust electronic health records or data registries to easily query.

The not-so-secret sauce

Dr. Udeh says while he wasn’t surprised by these findings, he was surprised by the strength of the association. Anecdotally, it’s something he and his colleagues have noticed for several years and now validated by the raw, objective data. While the team was heartened by the findings, Dr. Udeh is quick to point out that the so-called secret sauce of the program is in plain sight.

“There isn’t a special or different skill set. It’s the same physicians. We take turns staffing the tele-ICU overnight,” he says. “This model facilitates more efficient interventions. It allows us to shorten the time between recognition and intervention. We’re able to more quickly identify a change in a patient’s condition and alter the course of care before their condition becomes problematic.”

Importantly, it also helps address provider burnout. With one caregiver working overnight and covering several ICUs, daytime caregivers can get longer stretches of sleep at night, and the continuity of care is not sacrificed.

Current and future directions

Putting it into perspective, he says, the tele-ICU model, which has been in its current iteration for almost 20 years, is generally accepted in the clinical community. However, it’s still not without some skepticism. He says this data should reinforce the tele-ICU as a viable model of care.

The team plans to continue exploring the data and potentially drilling down to better understand how this model best serves patients with certain diagnoses or specific types of hospitals and health systems. Dr. Udeh concludes, “The start-up costs for this model are not insignificant, so allocating resources to make the biggest impact is key.”