ABSTRACTS from 16th International COnference on ... - CRRT Online

Telemedicine in the ICU: The Future is Here
Jeffrey Lipman MD
5:30-5:45
Thursday, February 16
Educational Objectives:
1. Understanding what telemedicine for remote Intensive Care Units can provide
2. Review of current data on telemedicine services
3. Demonstrate how care via a targeted individual consultative service can improve outcomes
Content Description:
Telemedicine (audiovisual technologies) is increasingly being used to assist ICUs unable to be staffed by intensivists.
Here I discuss recent data evaluating these services and their potential role in managing ICU patients.
Finally I provide some data on a targeted individual consultative service we have set up with a regional ICU.
Models of care range <strong>from</strong> complete remote 24-hour surveillance requiring direct video observation to a consultation
liaison service only requiring conventional telephone links. Early work suggests savings in terms of cost
and length of stay with an improvement in compliance with care protocols. However, later work is not as supportive,
possibly related to differing care infrastructures and the organisation of individual units. The key task is
to ascertain the most appropriate service requirements that would assist in care for a given patient circumstance.
Bundaberg Base is a regional 200-bed hospital serving a population near 45,000 with the closest tertiary centre
400 kilometres. They have no intensive care specialist. In 2009 daily ward rounds were undertaken by an intensive
care specialist Monday-Friday via a mobile wireless web-camera as part of a computer videoconferencing
system.
The telemedicine program reviewed near 220 patients per year in around 500 consultations. While the total number
of annual admissions (522-590) increased during the study period, illness severity (APACHE II 15.2-15.9)
and the proportions of deaths (8-9%) and transfers (11-13%) remained unchanged. ICU length of stay increased
by 30 hours and SMRs fell (57% APACHE III-J, 20% APACHE II and 14% SAPS II). Increased local nursing
resources were needed for the increased LOS.
There is conflicting evidence as to the benefit of an objective improvement in care and even less that formally
reviews the impact and contribution of ICU telemedicine to processes of care, the effects on unit staffing, hospital
organisation and the health care region. However, the technology is available and being embraced by some,
especially to deal with the tyranny of distance.
Suggested Reading:
1. Boots R, Singh S, Tereblanche M, Widdecombe N, Lipman J. Remote Care for an ICU - many models of
care can be effective Curr Opin Crit Care 2011;17:634-640
2. Morrison JL Cai Q, Davis N, Yan Y, Berbaum ML, Ries M, Solomon G. Clinical and economic outcomes of
the electronic intensive care unit: results <strong>from</strong> two community hospitals. Crit Care Med 2010;38:2-8.
3. Young L, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intenisve care unit
coverage on patient outcomes. Arch Intern Med 2011;171:498-506.
4. Lilly C, Cody S, Zhao H et al. Hospital mortality, length of stay, and preventable complications among criticallu
ill patients before and after Tele-ICU re-engineering of critical care processes. JAMA, 2011. 305.
5. Thomas E, Lucke JF, Wueste L, Weavind L, Patel B. Association of telemedicine for remote monitoring of
intensive care patients with mortality, complications, and length of stay. JAMA 2009;302:2671-2678.
6. Kahn J. Intensive care unit telemedicine: promises and pitfalls. Arch Intern Med 2011
54