The goal of a telemedicine ICU (tele-ICU) program is to bring the skills of experienced critical care physicians and nurses working remotely to facilities where equivalent bedside services aren't always available and to apply best-practice protocols to improve patient outcomes. And according to a report published early online in Critical Care Medicine, implementing a tele-ICU program can reduce patient mortality and decrease the length of both ICU and hospital stays.

Figure. Intensive care nurse Lisa Manion monitors the vital signs of patients in the ICUs of 10 hospitals in four states from the Mercy SafeWatch headquarters at St. John's Mercy Medical Center in Creve Coeur, Missouri. Photo by J.B. Forbes / St. Louis Post-Dispatch / MCT.

Beth Willmitch, RN and operations director of the tele-ICU system (eICU LifeGuard) at Baptist Health South Florida (BHSF), and colleagues examined clinical outcomes before and after implementation of the program in the ICUs of BHSF, a five-hospital health care system, beginning in December 2005. Only the largest hospital had round-the-clock bedside intensivist coverage (the level of care recommended by the Leapfrog Group to ensure patient safety); the others were open units, on which care was managed by private practice physicians. The tele-ICU program, operating 24 hours a day and staffed by one intensivist and three critical care nurses, was deployed in phases.

With the help of video monitoring equipment, two-way voice communication, and electronic patient data, the tele-ICU team monitored patients and partnered with the bedside nurses and physicians. Although the tele-ICU team's input was limited by the availability of data (handwritten charts weren't available unless faxed), as well as by the level of intervention permitted by admitting and consulting physicians, the results in the three years after implementation were clearly positive: analysis of 24,656 patient records showed decreases in severity-adjusted length of hospital stay of 14.2%, ICU stay of 12.6%, and the relative risk of death in the hospital of 23%.

The authors note that implementing a tele-ICU program is a complex process and requires a change in the culture of patient management; although the data show patient outcomes improved most when tele-ICU intensivists were proactive in their care, clinicians will need time to accept this level of involvement. ICU nurses, they note, also stand to benefit from immediate access to specialists and collaboration with tele-ICU nurses but will need to view them as clinical partners in order for such a system to succeed.-Laura Wallis

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