Implementing physician-guided telemedicine in intensive care units (ICUs) does not reduce patients’ length of stay, according to a large clinical trial in Brazil led by the Albert Einstein Israelite Hospital of São Paulo, in collaboration with the Brazilian Ministry of Health (PROADI-SUS program) and the Barcelona Institute for Global Health (ISGlobal), a center supported by the ”la Caixa” Foundation. The results, presented in section hot topics of the Congress of the European Society of Intensive Care Medicine held in Barcelona, and published simultaneously in JAMAsuggests that the best model for the provision of telecare in the ICU remains to be defined.
Caring for critically ill patients often requires a team of specialists, including intensive care doctors. However, these specialists escape all over the world, especially outside of large cities. One proposed solution is telemedicine, in which doctors remotely direct care in intensive care units (tele-ICU). “Despite the promise of telemedicine and its growing use, no large-scale study has tested whether this approach can actually improve patient outcomes in ICUs,” he says. Octavio RanzaniISGlobal researcher.
A trial with 30 ICUs in Brazil
In a new study called TELESCOPEFunded by the Brazilian Ministry of Health, the authors evaluated whether telemedicine could improve the efficiency of ICUs and reduce the length of stay of critically ill patients. Participated in the study 30 ICUs from public hospitals throughout Brazil. Half of the ICUs followed their usual care routines, while the other half received, in addition to usual care, daily telemedicine rounds, which consisted of meetings between the remote intensivist and the local team to discuss possible diagnoses and treatment plans. . and problems. 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 ran between June 2019 and July 2021.
The main question was Whether a doctor-led telemedicine model could shorten the time patients spent in the ICU. The short answer is no. The average stay in the ICU was practically the same both in the telemedicine group and in the usual care group: about 8 days. There were also no significant differences in other outcomes, such as infection and in-hospital mortality rates.
Several reasons may explain why telemedicine did not have a greater impact. “The issue appears to be more complex than ‘simply’ placing a remote intensivist doctor to connect daily with ICU teams. For example, issues related to multidisciplinary care (provided by intensive care nurses, respiratory/motor therapists, and clinical pharmacists) and management (care process, patient flow, communication, etc.) may be overlooked. Additionally, it could be that some ICUs in the study did not have enough resources or staff to fully benefit from the telemedicine model,” he says. Adriano Pereirafrom the Hospital Israelita Albert Einstein and lead co-author of the study. Additionally, the COVID-19 pandemic, which hit the country during the study, may also have sapped ICU resources and affected the results, although it is unclear why this would be different between the two groups.”
The authors conclude that, although telemedicine in this study did not reduce ICU stay, it does not mean that other telemedicine models do not work in other settings. Find the Best way to use this technology in intensive care. remains a challenge.
“Our study demonstrates that telemedicine in intensive care needs good scientific evidence to evaluate the different models, optimize its implementation and identify the contexts that could benefit the most,” say Ranzani and Pereira.
Reference
Pereira AJ, Noritomi DT, dos Santos MC et al. Effect of Tele-ICU on clinical outcomes of critically ill patients. The TELESCOPE randomized clinical trial. JAMA. October 2024. Doi: 10.1001/jama.2024.20651
