Tag: icu

Categories : HospitalsTags :

Life-saving Benefits of Telemedicine in ICUs

On By ModernMedia

A study in Cleveland, USA, showed that at hospitals without 24/7 on-site intensivists, those that had intensivists available to deliver telemedicine had lower ICU mortality rates.

Presented at the Society of Critical Care Medicine’s virtual 50th Critical Care Congress, Cleveland Clinic intensivist Dr Chiedozie Udeh, commented that the COVID pandemic has thrust ICU telemedicine into the spotlight.

“In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” Udeh said.

Out of patients treated at one of nine hospitals within the Cleveland Clinic Health System, patients receiving ICU telemedicine were 18% less likely to die and were discharged 2 days sooner than patients who received traditional ICU care, without 24/7 on-site intensivist care.  

The unadjusted 30-day mortality among the telemedicine patients was 5.5%, while in the standard care group it was significantly higher at 6.9%.ICU length of stay was significantly shorter in the ICU telemedicine group, as was the length of total hospital stay.

Udeh said that an intensivist monitoring patients via telemedicine has access to relevant data and can perform the same functions as an on-site clinician, short of physical contact. Intensivists can monitor multiple patients and have two-way communication with bedside nurses. Dedicated software is available, including tools to identify deteriorating patients needing care.

Speaking to MedPage Today, Udeh said ICU telemedicine offers an intermediate treatment strategy between large academic centres with 24/7 on-site intensivist care, and smaller hospitals without such care. More research is needed to understand how telemedicine leads to reduced mortality, he added.

“If I had to speculate I would imagine this would probably be due to patients’ receiving more timely needed interventions,” he said.

“We think these findings provide further reassurance about the value of ICU telemedicine, particularly in light of our collective experience in 2020,” said Udeh. “With the COVID-19 pandemic, telemedicine in general assumed greater prominence.”

CU telemedicine can benefit both large hospital systems and smaller, individual hospitals, he said.

“Smaller hospitals may have no intensivist at all or they may have only one,” he said. He added that, according to one recent survey, about half of US hospitals do not have an intensivist on staff.

ICU telemedicine still has considerable expenses associated with it, however; at $50 000 per bed in first year costs, it may be hard to justify for resource-constrained hospitals.

Source: MedPage Today

Presentation information: Udeh CI, et al “ICU telemedicine and clinical risks associated with 30-day mortality: a retrospective cohort study” SCCM2021.

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Interviews Reveal Most Important ICU Outcomes for Patients and Family

On By ModernMedia

A University of Pennsylvania study has explored the important aspects and outcomes attributed to high quality ICU care by patients and their families.

These may not match the metrics assigned by healthcare providers, which could prompt reassessment, especially considering the increasing numbers of patients successfully discharged from the ICU, and in light of the COVID pandemic (although this study was conducted prior to this).ICU care is typically assessed in terms of mortality rates, durations of stay, ventilator-free days, infection rates and other data from patient health records. On discharge from an intensive care unit (ICU), efforts will often address physical and cognitive functioning, and grief and depression.

This research was aimed at improving the understanding of patient- and family-centred care. Researchers from the Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania conducted hour-long semi-structured interviews with 19 ICU survivors, as well as 30 family members of patients who had either survived or died in ICU.

The key aspects of quality care in the ICU experience were communication, patient comfort and sensing that the medical team’s care was exhaustive. The researchers noted that time and effort put into patient communication was highly valued, often leading patients feeling less alone and afraid. Communication and patient comfort were especially important during the ICU experience, and are delivered by high quality nursing care.

Key post-ICU outcomes were consistently given as survival, quality of life, physical functioning and cognitive functioning. Although survival alone was commonly seen by 25% of participants as a key ICU outcome, some outcomes were seen as worse than death by many. These included an inability to communicate, having a severe physical disability or dependence on machines, and living with severe or constant pain.

Source: Newswise

Journal information: Auriemma, C.L., et al. (2020) What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study. American Journal of Critical Care. doi.org/10.4037/ajcc2021398.