Telemedicine in the Intensive Care Unit

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.[1] Telemedicine is “the practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication”.[2] 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’,[3] 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

References:

  1. 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.
  2. Merriam-Webster, Inc. Telemedicine. Merriam-Webster.com.
  3. Chen YF, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2015. [ePub].
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