cohort·critical care, epidemiology, internal medicine, observational study·PMC10519574
Telemedicine Critical Care-Mediated Mortality Reductions in Lower-Performing Patient Diagnosis Groups: A Prospective, Before and After Study
Critical Care Explorations · 18 authors, 8 centres
AI SUMMARY
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This prospective, before-and-after study evaluated the implementation of telemedicine critical care (TCC) in three ICUs, using APACHE diagnosis categories to identify a historically lower-performing patient group. In that targeted group, TCC implementation was associated with a significant reduction in standardized mortality ratio and risk-adjusted hospital mortality, while no such improvement was seen in the overall ICU or higher-performing patient groups.
Full summary
921 CHARS
This was a prospective, observational, before-and-after study conducted across three adult ICUs at an academic medical center. The intervention was TCC implementation, which included an acuity-driven workflow targeting patients in APACHE diagnosis categories with a pre-TCC standardized mortality ratio (SMR) >1.5. The primary outcome was risk-adjusted hospital mortality. For the overall ICU population, there was no significant change in SMR or risk-adjusted mortality. However, in the identified lower-performing group, risk-adjusted mortality decreased from 26.4% to 16.9% (p < 0.001), and SMR decreased from 1.61 to 1.03. In the higher-performing group, no changes were observed. Limitations include the single-center, observational design and lack of a control group. The results suggest that TCC benefits may be concentrated in historically lower-performing patient subgroups within otherwise high-performing ICUs.
