Managed critical care: impact of remote decision-making on patient outcomes

Objectives: Tele–intensive care unit (tele-ICU) use has become increasingly common as an extension of bedside care for critically ill patients. The objective of this work was to illustrate the degree of tele-ICU involvement in critical care processes and evaluate the impact of tele-ICU decision-making authority. Study Design: Previous studies examining tele-ICU impact on patient outcomes do not sufficiently account for the extent of decision-making authority between remote and bedside providers. In this study, we examine patient outcomes with respect to different levels of remote intervention. Methods: Analysis and summary statistics were generated to characterize demographics and patient outcomes across different levels of tele-ICU intervention for 82,049 critically ill patients. Multivariate logistic regression was used to evaluate odds of mortality, readmission, and likelihood of patients being assigned to a particular remote intervention category. Results: Managing (vs consulting) physician type influenced the level of remote intervention (adjusted odds ratio [AOR], 2.42). A higher level of tele-ICU intervention was a significant factor for patient mortality (AOR, 1.25). Female sex (AOR, 1.05), illness severity (AOR, 1.01), and higher tele-ICU intervention level (AOR, 1.13) increased odds of ICU readmission, whereas length of stay in number of days (AOR, 0.93) and consulting (vs managing) physician type (AOR, 0.79) decreased readmission odds. Conclusions: This study’s findings suggest that higher levels of tele-ICU intervention do not negatively affect patient outcomes. Our results are a step toward understanding tele-ICU impact on patient outcomes by accounting for extent of decision-making authority, and they suggest that the level of remote intervention may reflect patient severity. Further research using more granular data is needed to better understand assignment of intervention category and how variable levels of authority affect clinical decision-making in tele-ICU settings.