Telemedicine/Virtual ICU: Where Are We and Where Are We Going?

Abstract

Intensive care unit telemedicine (tele-ICU) is technology enabled care delivered from off-site locations that was developed to address the increasing complexity of patients and insufficient supply of intensivists. Although tele-ICU deployment is increasing, it continues to cover only a small proportion of ICU patients. This is primarily due to expense, with first-year costs exceeding $50,000 per bed. Meta-analyses of outcomes indicate survival benefits and quality improvements, albeit with significant heterogeneity. Depending on the context, a wide range of estimated incremental cost-effectiveness ratios reflects variable effects on cost and outcomes, such as mortality or length of stay. Tele-ICUs may fit within a hybrid model of care to complement high-intensity ICU staff coverage. However, more research is required to foster consensus and determine best practices. This review summarizes data on tele-ICU structure, operations, outcomes, and costs. Evidence was extracted from meta-analyses, with secondary data from Cleveland Clinic's tele-ICU experience.

Keywords: ICU; cost-effectiveness; critical care; intensive care unit; outcomes; telemedicine.

Conflict of interest statement

Conflict of Interest Disclosure: The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

Figures

Figure 1.

The operational structure of a tele-ICU program based on the experience at Cleveland Clinic. tele-ICU: telemedicine intensive care unit; CT: computed tomography; APRN: advanced practice registered nurse; RN: registered nurse; EMR: electronic medical records; IABP: intra-aortic balloon pump; ECMO: extracorporeal membrane oxygenation; LVAD: left ventricular assist device