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Multicenter Study
. 2018 Jul;154(1):69-76.
doi: 10.1016/j.chest.2018.04.021. Epub 2018 Jun 15.

ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration

Spyridon Fortis  1 , Mary V Sarrazin  2 , Brice F Beck  3 , Ralph J Panos  4 , Heather S Reisinger  2
Affiliations
Multicenter Study

ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration

Spyridon Fortis et al. Chest. 2018 Jul.

Abstract

Background: The effect of ICU telemedicine on transfers is not well studied. This study tests the hypothesis that ICU telemedicine decreases ICU patient interhospital transfers.

Methods: Data were retrieved for patients admitted to 306 Veterans Affairs ICUs in 117 acute care facilities between 2011 and 2015. Telemedicine was provided to 52 ICUs in 23 acute care facilities by two support centers located in Minneapolis and Cincinnati. We compared interhospital transfer rates in ICU telemedicine-affiliated hospitals with transfer rates of facilities with no telemedicine program. We used generalized linear mixed multivariable models to assess the association of ICU telemedicine with transfer rates and 30-day mortality.

Results: A total of 553,523 admissions to Veterans Affairs ICUs (97,256 to telemedicine hospitals; 456,267 to non-telemedicine hospitals) were analyzed. Transfers decreased from 3.46% to 1.99% in the telemedicine hospitals and from 2.03% to 1.68% in the non-telemedicine facilities between pre- and post-telemedicine implementation periods (P < .001). After adjusting for demographics, illness severity, admission diagnosis, and facility, ICU telemedicine was associated with overall reduced transfers with a relative risk (RR) of 0.79 (95% CI, 0.71-0.87; P < .001); this reduction occurred in patients with moderate (RR, 0.77; 95% CI, 0.61-0.98; P =.034), moderate to high (RR, 0.79; 95% CI, 0.63-0.98; P =.035), and high illness severity (RR, 0.73; 95% CI, 0.60-0.90; P =.003) and in nonsurgical patients (RR, 0.82; 95% CI, 0.73-0.92; P =.001). Transfers decreased in patients admitted with GI (RR, 0.55; 95% CI, 0.41-0.74, P < .001) and respiratory admission diagnoses (RR, 0.52; 95% CI, 0.38-0.71; P < .001). ICU telemedicine was not associated with an increase in 30-day mortality.

Conclusions: ICU telemedicine was associated with a decrease in interhospital ICU transfers.

Keywords: ICU telemedicine; interhospital transfers; mortality; tele-ICU.

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