Remote monitoring of ICU patients lowers mortality rates, complications

it might not be cost effective. A telemedicine system such as the one described in the study could enable a physician to monitor up to 40 or 50 patients at a time in multiple hospitals, compared to the 10 or 20 patients able to be monitored while working full time in a critical care unit.

For the study, researchers first collected outcomes data from an urban hospital's ICU during two 16-week periods one in the fall to adjust for seasonal illnesses and one in the spring.

Next, cameras and data transmission equipment used for remote care were installed in the ICU and in the homes of four Hopkins intensivists. During a 16-week period, the intensivists took turns providing round-the-clock monitoring of all ICU patients from home. They interacted with patients and hospital personnel and accessed clinical data via dedicated, computer-based video conferencing and data transmission equipment. Bedside monitoring data were transmitted in nearly real time via a telephone access system. Electrocardiograms, radiographs, consultant notes and bedside data flowsheets were scanned and transmitted digitally; laboratory data were accessed through a telephone terminal-emulation system.

The off-site clinicians participated in rounds via video conference, discussed individual cases with a senior member of the attending staff or bedside nurse at least twice a day, and were available by pager to discuss emergencies or patients newly admitted to the unit. Outcomes data during this period were collected.

There were 225 patients in baseline period one, 202 in baseline period two and 201 during the intervention. Death rates decreased during the intervention by 68 percent and 46 percent, compared with the first and second baseline period, respectively. Hospital mortality decreased by 33 percent and 30 percent; incidence of ICU complications decreased by 44 percent and 50 percent; ICU length of stay decreased by 34 percent and 30 percent; and ICU costs decreased by 3

Contact: Karen Blum
Johns Hopkins Medical Institutions

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