Daily multidisciplinary rounds conducted by a board-certified intensivist through telemedicine do not reduce intensive care unit (ICU) length of stay (LOS) in critically ill adult patients, according to a study published online Oct. 9 in the Journal of the American Medical Association to coincide with the annual congress of the European Society of Intensive Care Medicine, held from Oct. 5 to 9 in Barcelona, Spain.
Adriano J. Pereira, M.D., Ph.D., from the Hospital Israelita Albert Einstein in São Paulo, Brazil, and colleagues assessed whether an intervention involving daily multidisciplinary rounds and monthly audit and feedback meetings performed by a remote board-certified intensivist reduces ICU LOS versus usual care. The analysis included patients treated in 30 general ICUs in Brazil in which daily multidisciplinary rounds performed by board-certified intensivists were not routinely available (1,794 patients in the baseline period and 15,230 in the intervention period).
The researchers found that mean ICU LOS, adjusted for baseline assessment, did not differ significantly between the tele-critical care and usual care groups (8.1 versus 7.1 days). In sensitivity analyses and prespecified subgroups, results persisted. There were no statistically significant differences seen in any other secondary or exploratory outcomes, including ICU efficiency, in-hospital mortality, incidence of central line-associated bloodstream infections, ventilator-associated events, catheter-associated urinary tract infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation, and rate of patients with oxygen saturation values under that of normoxemia.
“This highlights the need but also the challenge of how to tailor telemedicine delivery models while guaranteeing a minimal adequate structure and qualifications at local sites,” the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
More information:
Adriano J. Pereira et al, Effect of Tele-ICU on Clinical Outcomes of Critically Ill Patients, JAMA (2024). DOI: 10.1001/jama.2024.20651
Kelly C. Vranas et al, Evaluating Complex Technological Innovations in Critical Care—Current Challenges and Future Directions, JAMA (2024). DOI: 10.1001/jama.2024.19854
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Tele-ICU rounds ineffective in shortening ICU stay for patients (2024, October 11)
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