Hospital mortality and length of stay before and after tele-ICU reengineering
Lilly 2011 trial design and results
Design
Prospective before-and-after evaluation study at a single academic centre
Treatment
Tele-ICU intervention with reengineered critical care processes
Control
Pre-intervention period
Population
6290 adults admitted to intensive care
Follow-up
Hospital discharge
Primary endpoint
Hospital mortality
Result
Hospital mortality was 13.6% (95% CI 11.9% to 15.4%) before the intervention and 11.8% (10.9% to 12.8%) during the tele-ICU period, with reduced adjusted odds of mortality, shorter length of stay and fewer preventable complications.
Secondary endpoints
Length of stay, preventable complications, adherence to best practice
In a single academic medical center study, implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with improvements in best practice adherence and lower rates of preventable complications.
The trial authors, in the published abstract
How it has aged
The intervention bundles telemedicine with process reengineering, so what actually helped is unclear. Before-and-after at one centre, and Thomas 2009 found nothing when studying remote monitoring alone — which suggests the reengineering mattered more than the cameras.
Publications
Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes
Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA 2011 Jun 1;305(21):2175-83.
Hospital mortality 13.6% before versus 11.8% during the tele-ICU period
Shorter length of stay and fewer preventable complications