Telemedicine Does Not Appear to Reduce ICU Patient Stays

Telemedicine has had a profound impact on the way care is delivered to patients. Its many advantages have led to its increased use, not to mention the crucial role it played in ensuring care during the COVID-19 pandemic. In some cases, however, there is still debate about how best to utilize telemedicine for real benefits.

One area in particular where the use of telemedicine has been proposed is in the care of critically ill patients in intensive care units (ICUs). Specialists capable of caring for such patients, such as intensivists, are scarce worldwide, especially outside major cities. As a result, telemedicine interventions have been proposed where doctors can guide care in ICUs remotely (tele-ICU). However, large-scale studies to measure the effects of this type of care in this particular sector of medicine are lacking.

To address this lack of data and to assess whether telemedicine can effectively improve ICU patient outcomes and reduce the length of stay, the Albert Einstein Israelite Hospital in São Paulo, Brazil, led a large-scale clinical trial in collaboration with the Brazilian Ministry of Health (PROADI-SUS program) and the Barcelona Institute for Global Health, Barcelona, Spain.

The trial, called TELESCOPE, demonstrated that physician-guided telemedicine in ICUs does not reduce the length of patient stays. Therefore, the authors concluded that the best model for providing tele-ICU care has yet to be determined.

The study results, published in JAMA, were also presented in the Hot Topics section of the 37th Congress of the European Society of Intensive Care Medicine, held in Barcelona from October 7 to 9, 2024.

Methodology and Results

The Brazilian study involved 30 ICUs from public hospitals across Brazil. Half of the ICUs followed their usual care routines, while the other half, in addition to usual care, conducted daily telemedicine rounds, which consisted of meetings between the remote intensivist and the local team to discuss potential diagnoses, treatment plans, and issues. The specialist also provided the medical team with updated treatment guidelines and held monthly virtual sessions to review ICU quality indicators. More than 17,000 critically ill patients participated in the trial, which took place between June 2019 and July 2021.

The results show that the average ICU stay was almost the same in both the telemedicine and usual care groups: About 8 days. There were also no significant differences in other outcomes, such as infection rates and in-hospital mortality.

Relevance and Implications of the Study

The authors suggest several hypotheses to explain the lack of benefits in the telemedicine group. “The issue seems to be more complex than simply placing a remote intensivist to connect daily with ICU teams. For example, aspects related to multidisciplinary care (provided by ICU nurses, respiratory/physical therapists, and clinical pharmacists) and management (care process, patient flow, communication, etc.) may be overlooked. Additionally, some ICUs in the study may not have had sufficient resources or staff to fully benefit from the telemedicine model,” said Adriano Pereira, a physician at the Albert Einstein Israelite Hospital and co-lead author of the study, in a press release.

The authors stated that although telemedicine did not reduce ICU stays in this study, it does not mean that other telemedicine models wouldn’t work in other settings. However, in the specific field of intensive care, finding the best way to use this technology remains a challenge.

The trial conducted in Brazil is of great international significance, as it is the first large-scale study on the effect of telemedicine in monitoring ICU patients. The data collected in this study could pave the way for future research to find the best way to use telemedicine, both in ICUs and other settings.

This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.