The Costs of Critical Care Telemedicine Programs

Abstract

ICUs deliver focused care to critically ill patients; but despite advances in ICU care, mortality rates remain high and vary significantly. 1,2 There is an increased effort to improve patient outcomes by providing dedicated intensivist staffi ng in all ICUs and promoting adoption of evidence-based therapies. [3][4][5][6][7][8] Access to intensivists has been hampered by an array of factors, most notably the limited supply of intensivists, particularly for smaller hospitals and rural geographic regions. [9][10][11] To improve the quality of critical care and extend the reach of the current intensivist workforce, at least 40 health-care systems in the United States have implemented telemedicine programs in ICUs (tele-ICUs). [12][13][14][15] Tele-ICUs typically combine real-time videoconferencing, telemetry, and electronic health records (EHRs). A tele-ICU allows physician and nurse intensivists located in a centralized monitoring center to monitor and care for patients in multiple distant ICUs. 16,17 Although the tele-ICU concept may be similar across facilities, the technology and associated treatment protocols (eg, ventilator protocols, sepsis management, best practice protocols) can vary signifi cantly across Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identifi ed eight studies reporting tele-ICU costs. These studies suggested combined implementation and fi rst year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and fi rst year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions:The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profi ts is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.

Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units

“…3 Additional research is needed to further delineate issues related to tele-ICU that specifically affect nursing practice. A recent systematic review 17 indicated that the cost of tele-ICU implementation is substantial and that the impact of these programs on hospital costs or profits is unclear. No information on costs related to tele-ICU nursing care or on alternative nurse staffing models is currently available.…”

Liver Transplantation for Hemoperitoneum Secondary to Huge Multiple Hemangiomatosis: A Case Report of a Tele-intensive Care Unit in Deceased-Donor Management

“…It is well known that telemedicine has been used in several healthcare areas for improving outcomes, lowering costs, and heightening patient access to high levels of care. 5,6 Ours is a positive story of the value of tele-ICU technology in rendering critical care to a patient and validated the use of tele-ICU technology when donor organs are identified in a rural hospital that does not have a trauma unit or board-certified anesthesiologists. A remotely based critical care team can be networked with the bedside ICU team via state-of-the-art audiovisual communication and computer systems.…”

Impact of Nurse-Led Remote Screening and Prompting for Evidence-Based Practices in the ICU*

“…We estimate the costs of our intervention to be approximately $380,000 at start-up and approximately $900,000 annually, including hardware, staffing and administrative costs. These costs are substantially less than the costs of a full telemedicine program, which can exceed $3 million annually (23). Given the reductions in duration of mechanical ventilation we observed, the intervention is likely to have resulted in substantial cost savings (13), making this intervention budget neutral even under conservative assumptions.…”