I promised in the last blog to provide a brief summary of a review article on the above topic in the journal of Critical Care Medicine. Telemedicine is “the practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication”. I was surprised to learn that 11% of hospital ICU beds in the US are served by a continuously monitoring telemedicine programme, and that this proportion continues to increase. The review found that implementation of telemedicine is associated with reduced ICU length of stay (just over half a day) and reduced ICU mortality (20% decrease in relative risk). However, the studies all use before and after designs and the article is not ‘reflective’ – it does not discuss the possibility of a ‘rising tide phenomenon’, or regression to the mean (see previous blog). Malpractice claims following implementation of telemedicine dipped precipitously in a single quoted study, but this could be subject to publication bias. However, process measures observed sporadically among some studies appear to improve when telemonitoring is introduced, so there is a plausible basis for improved outcomes. On balance I think this was a rather uncritical review, but, pending better quality studies, my interim conclusion is that telemedicine is more likely to do good than harm.
— Richard Lilford, CLAHRC WM Director
- Lilly CM, Zubrow MT, Kempner KM, et al. Critical Care Telemedicine: Evolution and State of the Art. Crit Care Med. 2014; 42(11): 2429-36.
- Merriam-Webster, Inc. Telemedicine. Merriam-Webster.com.
- Chen YF, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2015. [ePub].