Amsterdam, the Netherlands – As the adoption and growth of intensive care unit (ICU) telemedicine increases, more research is being conducted to analyze operational factors that affect patient outcomes. Royal Philips (NYSE: PHG AEX: PHIA) offers the eICU telemedicine program that combines technology and clinical processes to improve outcomes. Philips points to a new study in CHEST that reveals the level of intervention by eICU providers was associated with shorter ICU lengths of stay (LOS).
The study examined how eICU and bedside clinical teams at a major health system worked to deliver care. Results of the study show ICUs that were more fully integrated with the remote team were associated with shorter lengths of ICU and hospital stays, suggesting that more teamwork and direct intervention allows for quicker patient intervention to manage evolving instability and prevent complications.
“As health systems seek to better manage their populations to improve outcomes while lowering costs, telemedicine offers a way to continuously monitor patients even as we face a shortage of healthcare providers,” said Brian Rosenfeld, MD, Chief Medical Officer, Hospital to Home, Philips. “Studies like this one demonstrate what we have known for years, which is that the value of leveraging a centralized telemedicine care model, based on leading Philips technology and program design, standardizes workflows and delivers the improved LOS outcomes when the on-site and remote teams are working together to support patient care.”
The retrospective, comparative study entitled, “ICU Telemedicine Co-Management Methods and Length of Stay,” analyzed 14,362 adult patients who were discharged from eight adult medical and surgical ICUs from a single health care system in 2012. Each of the eight participating units were classified into one of three ICU telemedicine co-management groups based on how the remote eICU and bedside teams worked together: 1) direct intervention from the eICU staff with timely communication to the bedside team; 2) monitoring from the remote eICU with notification to the bedside team of the need for intervention; and 3) a mix of both of these methods.
The study found more direct remote eICU physician intervention resulted in significantly shorter ICU lengths of stay. Because the direct intervention model encourages eICU intensivists to deliver care to the patient at the time it is needed, this model had the largest ratio of remote eICU physician orders (11 per patient stay). Meanwhile, the monitor and notify approach averaged less than one eICU physician order per patient stay, as care delivery was primarily assumed by the bedside staff. The direct intervention group had an ICU LOS that was 42% less than predicted by Acute Physiology and Chronic Health Evaluation (APACHE), while the monitor and notify group was only 18% less than predicted by APACHE (p < 0.001). For hospital length of stay, the direct intervention group was 32% less than predicted by APACHE, while the monitor and notify group was 17% less than predicted by APACHE (p < 0.001).
The severity of the patient’s condition did not explain these results, as the monitor and notify group had significantly lower levels of acuity (APACHE IV score of 59.27) than the direct intervention group (APACHE IV score of 64.02). Despite this, both the raw and acuity adjusted lengths of stay were significantly shorter for the direct intervention group.
“Telemedicine has the power to improve care, but not all telemedicine is created equally,” said Dr. Craig Lilly, M.D., Professor of Medicine, Anesthesiology and Surgery at the University of Massachusetts Medical School and Director of the eICU Program at UMass Memorial Medical Center. “Technology alone cannot transform how healthcare works – it’s about empowering those who deliver care. This study showed that changing workflows to make the off-site eICU telemedicine team a core part of the treatment team was critical to changing outcomes.”
The study was co-authored by Helen Hawkins, Ph.D., Senior Product Owner at Philips Hospital to Home, Craig M. Lilly, M.D., Professor of Medicine, Anesthesiology and Surgery at the University of Massachusetts Medical School and Director of the eICU Program at UMass Memorial Medical Center, David A. Kaster, IT BI Integration Senior Consultant at Banner Health, Robert H. Groves, Jr., M.D., Vice President of Health Management at Banner Health and Hargobind Khurana, M.D., Senior Medical Director at Banner Health.
The Philips eICU program is part of a suite of enterprise telemedicine solutions delivered by Philips to help improve outcomes, provide better value and expand access to care. These programs help address multiple cohorts within a population ranging from highest cost patients with intensive ambulatory care and acute needs, to discharge transition and chronic patient management, to prevention and healthy living for the general population. These programs use a proactive care model to clinically transform the delivery of care to address growing clinician shortages while helping to improve patient outcomes.
For more information on the full suite of Philips clinical telemedicine programs, visit www.hospitaltohome.philips.com.