Association of Health Information Technology and Teleintensivist Coverage With Decreased Mortality and Ventilator Use in Critically Ill Patients

Abstract

The use of HITB-RIC was associated with significantly lower mortality and less ventilator use in critically ill patients.

Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

“…We speculate that bedside and off-site team collaboration is an important determinate of favorable associations of a tele-ICU intervention with outcomes. This hypothesis is supported by the observation that studies that failed to detect significant favorable tele-ICU associations with outcomes included a pathway for bedside physicians to decline participation of the off-site team in patient care, while our workflow processes and other studies reporting significant favorable associations with outcomes for a tele-ICU intervention 20,[35][36][37] did not provide an opt-out pathway.…”

Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit

“…Previous studies in tele-ICU have suffered from an inability to standardize practice to all patients in the covered ICUs [12,15]. In contrast, in centers where tele-ICU interventions were mandatory and uniform, a mortality benefit was demonstrated [8,17]. We found that, by limiting the tele-ICU team to consultative care, bedside providers were more accepting and that the primary surgical teams allowed all of their patients to participate.…”

“…For example, McCambridge et al [17] characterized the tele-ICU as one component of a coordinated health care information technology bundle. The governance structure of ICU care within the University of Massachusetts-Memorial health care system was restructured and centralized before a tele-ICU implementation [3].…”

“…Multiple studies have evaluated the efficacy of tele-ICU, and the results have been mixed [8,[12][13][14][15][16][17]. Telemedicine is a complex cultural and technical intervention, and some of the variation in study results could be caused by the context in which telemedicine was implemented, used, and supported within the hospitals [18] .…”

“…Since the first study showing outcome benefit of a telemedicine intervention in the ICU, there has been increasing adoption of tele-ICU nationwide and several important studies of its effects on morbidity, mortality, and processes of care [1,8,[13][14][15][16][17], but the staff in 1 tele-ICU system had variable attitudes about teamwork and safety climates as they related to tele-ICU [11]. We had previously conducted site visits and discussions with ICU physicians and nurses at active tele-ICUs and believed that perceptions toward telemedicine in the ICU were an important factor in success [10].…”