LAUSR

BACKGROUND Tele-Intensive Care Unit (ICU) augmentation has been associated with improvements in clinical and financial outcomes in many cases, but not all. Understanding this discrepancy is of interest given the clinical impact and intervention cost. A recent meta-analysis noted an association with mortality reduction and pre Tele-ICU standardized mortality ratio (SMR) of >1. RESEARCH QUESTION Does Tele-ICU implementation affect adjusted-mortality outcomes. If so, in what context? STUDY DESIGN AND METHODS We performed a retrospective pre-post analysis comparing before versus after Tele-ICU implementation on the outcome of risk-adjusted ICU mortality during AM versus PM admissions as well as other objective measures of Tele-ICU involvement. RESULTS 1,581 patient-stays and 14,584 patient-stays were available for analysis in the pre versus post Tele-ICU implementation period, respectively. The average APACHE IVa score was 46.6 versus 54.8 (p<0.01) in the AM pre Tele-ICU versus AM post Tele-ICU groups, respectively. The average APACHE IVa score was 47.2 versus 56.3 (p<0.01) in the PM pre Tele-ICU versus PM post Tele-ICU groups, respectively. Overall, the risk-adjusted ICU mortality was 8.7% pre Tele-ICU implementation versus 6.5% (p<0.01) after implementation. When stratified by AM admission and PM admission groups, no significant difference in risk-adjusted ICU mortality was seen in the AM stratum. In the PM stratum, risk-adjusted mortality was 10.8% before Tele-ICU versus 7.0% (p<0.01) after Tele-ICU implementation. The pre implementation SMR in the AM admission stratum was 0.95 versus 1.30 in the PM stratum. INTERPRETATION We found a reduction in risk-adjusted ICU mortality with implementation of Tele-ICU driven predominantly within the PM admission group. The PM admission SMR was 1.30 which may suggest an association with pre Tele-ICU implementation SMR >1 and mortality reduction. Future studies should seek to confirm this finding and explore other important Tele-ICU outcomes in the context of observed to expected ratios.