Are eICUs as efficient as some studies portray?

While remote monitoring of intensive care units promises to stretch the skills of an inadequate pool of specialists, a recent New York Times article questions whether eICUs actually improve care for patients or the bottom line for hospitals.

According to the article, while some studies linked to companies that sell such systems have produced large declines in mortality in addition to huge return on investment, other independent studies have found just the opposite in terms of the latter, with no significant impact on survival rates, complications or length of stay.

What's more, some hospitals adopted the technology, then ditched it, according to the Times, including NewYork-Presbyterian Hospital and Kaleida Health in Buffalo, as well as hospital systems in Michigan, Texas and Kentucky.

Mary Jo Gorman, founder and president of Advanced ICU Care, which offers such remote services, told the Times that hospitals can reap an extra $2,000 to $3,000 per patient after paying annual fees ranging from $750,000 to $2 million.

However, a University of Iowa review of previous studies, also mentioned in the article, found there's too little data to show that eICUs improve patient outcomes or provide a return on investment that can reach $50,000 to $100,000 per bed. That study, lead by Gaurav Kumar, a fellow at the University of Iowa who is also affiliated with the Veterans Administration Medical Center in Iowa City, reviewed eight studies, covering 29 ICUs and 26 hospitals.

Larry Hegland, chief medical officer at Ministry Saint Clare Hospital in Wisconsin, meanwhile, told FierceMobileHealthcare last year that use of Advanced ICU's services helped his facility reduce length of stay and cut its readmission rate 10 to 15 percent below the national average for hospitals of its size. Rather than the traditional "sunrise to sunset" culture in ICU, the service allowed patients to be actively treated 24 hours a day, he said.

Matthew Fink, a neuro-intensivist who heads neurology at NewYork-Presbyterian and is skeptical of tele-ICU, told the Times that nurses, not gadgets, are the key to success in a good ICU. "The companies that produce this technology want to sell it, so they are going to push it very hard," he said.

As more hospitals turn to eICUs, the American Association of Critical-Care Nurses recently issued practice guidelines for tele-ICU nurses, stating that clearly defined roles are vital to ensure quality and safety.

To learn more:
- find the Times article

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