A business case for tele-intensive care units.

OBJECTIVES A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. METHODS This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. RESULTS The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. CONCLUSIONS Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU.

[1]  A. Coustasse,et al.  Expanding technology in the ICU: the case for the utilization of telemedicine. , 2014, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[2]  Angelo Venditti,et al.  Tele-ICU "myth busters". , 2012, AACN advanced critical care.

[3]  E. Thomas,et al.  Tele-ICU: Experience To Date , 2010, Journal of intensive care medicine.

[4]  Virtual ICUs, lower operational costs. , 2008 .

[5]  Todd Dorman,et al.  Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care , 2000, Critical care medicine.

[6]  Neill KJ Adhikari,et al.  The effect of telemedicine in critically ill patients: systematic review and meta-analysis , 2012, Critical Care.

[7]  L. Nelson,et al.  Clinical outcomes after telemedicine intensive care unit implementation* , 2012, Critical care medicine.

[8]  Eli Perencevich,et al.  The costs of critical care telemedicine programs: a systematic review and analysis. , 2013, Chest.

[9]  J. Bander,et al.  Different Systems and Formats for Tele-ICU Coverage: Designing a Tele-ICU System to Optimize Functionality and Investment , 2012, Critical care nursing quarterly.

[10]  B. Hales,et al.  A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. , 2011, JAMA.

[11]  P. Pronovost,et al.  Impact of critical care physician workforce for intensive care unit physician staffing. , 2001, Current opinion in critical care.

[12]  S. Goran,et al.  A second set of eyes: An introduction to Tele-ICU. , 2010, Critical care nurse.

[13]  Marshall L. Smith,et al.  Intensive care telemedicine: evaluating a model for proactive remote monitoring and intervention in the critical care setting. , 2008, Studies in health technology and informatics.

[14]  Michael L Berbaum,et al.  Clinical and economic outcomes of the electronic intensive care unit: Results from two community hospitals* , 2010, Critical care medicine.

[15]  E. Thomas,et al.  Costs and cost-effectiveness of a telemedicine intensive care unit program in 6 intensive care units in a large health care system. , 2011, Journal of critical care.

[16]  R. Berenson,et al.  Does telemonitoring of patients--the eICU--improve intensive care? , 2009, Health affairs.

[17]  Zang Li,et al.  The use of RFID in healthcare: Benefits and barriers , 2010, 2010 IEEE International Conference on RFID-Technology and Applications.

[18]  Michael Ries.  Tele-ICU: A New Paradigm in Critical Care , 2009, International anesthesiology clinics.

[19]  M. Nielsen,et al.  Telemedicine in the intensive care unit. , 2012, Critical care nursing clinics of North America.

[20]  D. Bates,et al.  The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care* , 2005, Critical care medicine.

[21]  A. Pittard,et al.  Intensive care unit environment , 2009 .

[22]  K. Reed,et al.  The virtual ICU (vICU): a new dimension for critical care nursing practice. , 2008, Critical care nursing clinics of North America.

[23]  Chad M. Miller,et al.  Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care. , 2007, Surgical neurology.

[24]  REMOTE ICU CARE CORRELATES WITH REDUCED HEALTH SYSTEM MORTALITY AND LENGTH OF STAY OUTCOMES , 2007 .

[25]  B. Rosenfeld,et al.  ADOPTION RATE OF BLOOD TRANSFUSION EVIDENCE IN THE INTENSIVE CARE UNIT , 2008 .

[26]  Pascale Carayon,et al.  Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety. , 2013, Journal of critical care.

[27]  E. Thomas,et al.  The impact of a tele-ICU on provider attitudes about teamwork and safety climate , 2010, Quality and Safety in Health Care.

[28]  K. Matuszewski,et al.  Intensive Care Unit Telemedicine: Review and Consensus Recommendations , 2007, American journal of medical quality : the official journal of the American College of Medical Quality.

[29]  David J. Stone,et al.  Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: An alternative paradigm for intensivist staffing* , 2004, Critical care medicine.

[30]  Lance Brendan Young,et al.  Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. , 2011, Archives of internal medicine.

[31]  Cinda Becker.  Remote control. Specialists are running intensive-care units from remote sites via computers, and at least one health system with the e-ICU is reaping financial rewards--and saving lives. , 2002, Modern healthcare.

[32]  Sajeesh Kumar,et al.  Tele-ICU: efficacy and cost-effectiveness of remotely managing critical care. , 2013, Perspectives in health information management.

[33]  A. Coustasse,et al.  Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. , 2014, Perspectives in health information management.

[34]  Huifang Zhao,et al.  Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. , 2011, JAMA.

[35]  C. Lyden.  From Paper to Computer Documentation: One easy step? , 2008 .

[36]  C William Hanson,et al.  The effect of ICU telemedicine on mortality and length of stay , 2012, Journal of telemedicine and telecare.

[37]  Amber E Barnato,et al.  Use of intensive care at the end of life in the United States: An epidemiologic study* , 2004, Critical care medicine.

[38]  Alberto Coustasse,et al.  Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review. , 2013, Perspectives in health information management.

[39]  Robert Fromm,et al.  Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System , 2009, Postgraduate medicine.

[40]  Teresa A Rincon,et al.  THE IMPACT OF USING A STANDARD PROTOCOL FOR THE SURVIVING SEPSIS 6 AND 24 HR BUNDLES IN SEPTIC PATIENTS ON TOTAL ICU RISK ADJUSTED MORTALITY.: 391 , 2006 .