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Telemedicine in the Intensive Care Unit:  Effect of a Remote Intensivist on Outcomes

M. Elizabeth Wilcox, MD, MPH1; Jeanine P. Wiener-Kronish, MD2
[+] Author Affiliations
1Interdepartmental Division of Critical Care, University Health Network, Toronto, Ontario, Canada
2Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
JAMA Intern Med. 2014;174(7):1167-1169. doi:10.1001/jamainternmed.2014.289.
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Access to intensivists affects patient outcomes; high-intensity staffing (transfer of care to an intensivist or a mandatory consultation with an intensivist) is associated with reduced intensive care unit (ICU) and hospital mortality rates.1 The addition of in-hospital nighttime intensivists seems to reduce mortality rates in ICUs with low-intensity staffing but not those with high-intensity staffing.2 So how can our community address this variation in intensivist staffing, which seems to dramatically alter outcomes? For example, is it possible for ICUs with low-intensity staffing or no intensivist staffing to achieve the same beneficial outcomes of high-intensity staffing by using technology? Telemedicine (TM) has been touted as a technological advance that may help when there is a paucity of intensivists, allowing more patients access to specialty care without the risk of being transferred. Telemedicine, broadly defined as the exchange of medical information via electronic communication, allows for real-time exchange of clinical data and direct interaction among care providers across distances and provides decision support to underserviced rural areas, small hospitals without intensivists, and large hospitals with low-intensity physician staffing models or nocturnal physician shortages.

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