Evaluating Telemedicine in the ICU

A more defined concept of the intensive care unit (ICU) is necessary before hospitals can make use of new communication and information technologies; a better idea of what constitutes intensive care will determine how telemedicine can improve it.

Telemedicine uses electronic information and communication to provide health care assistance from a remote location. In intensive care telemedicine (tele-ICU), physicians and nurses, in a central monitoring facility, use bedside cameras and electronic information to monitor patients at intensive care units (ICUs) in several hospitals. The remote care team delivers instructions to caregivers at each ICU.

The Journal of the American Medical Association (JAMA) published the findings of the first federally-funded multi-center evaluation of tele-ICU. This editorial, from the pages of JAMA, comments on the study. The authors briefly summarize the findings of the study and point out its limitations. The discussion then turns to developing a general frame of reference for ICU care. Finally, the authors propose an approach to future research.

Key Findings:

  • The six-ICU study found no overall benefits with the tele-ICU program. There were benefits among sicker patients.
  • A conceptual framework for the ICU will include structural components, types of staff interaction, and the various processes of care undertaken in ICUs.
  • Future interventions should take place where tele-ICU is most likely to be beneficial, such as rural settings or in hospitals lacking intensivists.

Effective ICU care has been shown to reduce hospital stays and mortality rates. Tele-ICU could extend intensivist care to hospitals that do not have it.