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Association of Health Information Technology and Teleintensivist Coverage With Decreased Mortality and Ventilator Use in Critically Ill Patients
Matthew McCambridge, MD;
Kari Jones, PhD;
Hannah Paxton, RN, MPH;
Kathy Baker, RN, MPH;
Elliot J. Sussman, MD;
Jeff Etchason, MD
Arch Intern Med. 2010;170(7):648-653.
Background Little evidence exists to support implementing various health information technologies, such as telemedicine, in intensive care units.
Methods A coordinated health information technology bundle (HITB) was implemented along with remote intensivist coverage (RIC) at a 727-bed academic community hospital. Critical care specialists provided bedside coverage during the day and RIC at night to achieve intensivist coverage 24 hours per day, 7 days per week. We evaluated the effect of HITB-RIC on mortality, ventilator and vasopressor use, and the intervention length of stay. We compared our results with those achieved at baseline.
Results A total of 954 control patients who received care for 16 months before the implementation of HITB-RIC and 959 study patients who received care for 10 months after the implementation were included in the analysis. Mortality for the control and intervention groups were 21.4% and 14.7%, respectively. In addition, the observed mortality for the intervention group was 75.8% (P < .001) of that predicted by the Acute Physiology and Chronic Health Evaluation IV hospital mortality equations, which was 29.5% lower relative to the control group. Regression results confirm that the hospital mortality of the intensive care unit patients was significantly lower after implementation of the intervention, controlling for predicted risk of mortality and do-not-resuscitate status. Overall, intervention patients also had significantly less (P = .001) use of mechanical ventilation, controlling for body-system diagnosis category and severity of illness.
Conclusion The use of HITB-RIC was associated with significantly lower mortality and less ventilator use in critically ill patients.
Author Affiliations: Divisions of Critical Care Medicine (Dr McCambridge) and General Internal Medicine (Drs Sussman and Etchason), Department of Community Health, Health Studies, and Education (Drs Jones and Etchason and Mss Paxton and Baker), Lehigh Valley Health Network, Allentown, Pennsylvania; Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey (Dr McCambridge); and Department of Medicine, College of Medicine, University of South Florida, Tampa (Dr Sussman).
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