A consultative telemedicine service improves compliance with best practice guidelines in a highly staffed intensive care unit

Introduction: Telemedicine in the intensive care unit (ICU) is in the nascent stages of its development and usage. Little is known about its potential to improve quality of care in the ICU environment.Hypothesis: A consultative ICU telemedicine service improves compliance with best care practices in a highly staffed ICU of an academic medical center.Methods: We conducted a prospective study over a 10 week period. Best practice measures were defined relating to mechanical and pharmacological deep venous thrombosis (DVT) prophylaxis, gastric and decubitus ulcer prophylaxis, and prophylaxis against ventilator associated pneumonias (VAP). Baseline rates were collected during the first 2 weeks of the study period. A remote, consultative ICU telemedicine service was then implemented using two-way audio-visual communication, existing electronic documentation and real-time physiologic monitoring. Staffing was by an intensivist and nurse between 7p-7a daily. Compliance with the best practice measures was checked and recommendations to improve observed deficiencies were made for the 8 week intervention period. Pre and post-intervention data was analyzed using the Chisquare test.|Results: Baseline metrics were gathered for 125 patients pre- and 605 patients post-intervention. Compliance was defined as either adherence to best practice or presence of a therapeutic contraindication. Compliance improved for both mechanical (93.6% vs 98.2%; p24 hours were assessed for VAP prophylaxis. Compliance to sedation holidays (69.7% vs 85.5%; p0.05). There were no differences in compliance for stress ulcer prophylaxis (86.4% vs 81.5%; p>0.05), regular repositioning for decubitus ulcer prophylaxis (85.6% vs 90.9%; p>0.05) or elevation of the head of the bed 30 degrees (75.2% vs 73.6%; p>0.05).Conclusions: A consultative ICU telemedicine service made clinically significant improvements in adherence with and documentation of best care practices in a highly staffed academic ICU.