WASHINGTON – Nearly 10 percent of U.S. hospital intensive care unit beds use advanced telemonitoring, yet no one has studied how it affects cost and quality of care, according to a new report.
In a study published Thursday in Health Affairs, researchers from the Center for Studying Health System Change found hospital clinical leaders hold strong views about the use of telemonitoring – or eICU – but they have little information to go on.
"The rapid diffusion of eICUs in hospitals across the country, which remains largely unstudied, illustrates the need for comparative effectiveness initiatives to include innovations in how we care for patients – not just specific drugs, devices and services," said HSC Senior Consulting Researcher Robert A. Berenson, MD.
"Proponents and detractors of eICUs feel strongly that their assessments are correct," Berenson said. "But without a rigorous assessment, who knows which side is right?"
The Health Affairs article, titled "Does Telemonitoring of Patients – The eICU – Improve Intensive Care?" was a follow-up study from HSC's 2007 site visits to 12 communities – Boston, Cleveland, Greenville, S.C., Indianapolis, Lansing, Mich., Little Rock, Ark., Miami, northern New Jersey, Orange County, Calif., Phoenix, Seattle and Syracuse, N.Y. HSC has been tracking these markets since 1995.
During the visits, HSC researchers learned that hospital systems in Indianapolis, Little Rock, Miami, Phoenix and Seattle had adopted eICU systems. In a follow-up study, researchers interviewed clinicians in the five hospital systems with an eICU, as well as those in 19 non-eICU hospitals in the other 12 markets and national experts on ICU staffing, quality and ICU telemedicine.
An eICU system combines telemedicine with software applications to manage ICU patients from a central monitoring station, usually located off-site from the actual ICU and staffed with physicians with advanced training in critical care (known as intensivists), critical care nurses and administrative personnel.
HSC researchers found that hospitals adopting eICUs generally were motivated by the potential to improve clinical quality and patient safety rather than expectations of cost savings from reduced complications and lengths of stay.
Among hospitals not adopting eICUs, there was general agreement that the limited potential benefits did not justify significant upfront and ongoing operating costs – estimated at $3 million to $5 million in startup costs for 100 ICU beds, along with ongoing annual operating and staff costs of $1.3 million to $2.3 million per 100 beds. Virtually all of the hospitals without eICUs believed their current on-site ICU staffing was adequate and preferable to off-site staff.
The lack of third-party reimbursement also was seen as an argument against adopting eICUs.
Despite the lack of specific payments or other incentives, most hospitals in the study, with and without eICUs, were working to improve ICU performance, primarily by adding more intensivists and adopting ICU-specific quality improvement tools to help prevent ventilator-associated pneumonia and central-line infections, the study showed.
In all but one of the five eICU hospitals, poor interoperability between the eICU software and the hospitals' enterprise-wide information technology systems created barriers to using the eICU's advanced monitoring and outcome analysis features, according to the study.
