Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals.

OBJECTIVE

To determine the impact of a telemedicine system, the electronic intensive care unit (eICU), on ICU, and non-ICU mortality, total mortality, total and ICU-specific length of stay, and total hospital cost at two community hospitals.

DESIGN

Observational study with one baseline period and two comparison periods (eICU wave one and eICU wave two). Each time period was 4 months in duration.

SETTING

Four ICU from two community hospitals in the metropolitan Chicago area. Hospital one is a 610-bed teaching hospital with three adult ICU (ten-bed medical ICU, ten-bed cardiac ICU, and 14-bed surgical ICU). Hospital two is a 185-bed nonteaching hospital with a ten-bed mixed medical/surgical ICU.

PATIENTS

All patients 18 yrs or older with an ICU stay of at least 4 hrs during the specified time period were included.

INTERVENTIONS

The eICU was implemented at both hospitals in April 2003.

MEASUREMENTS AND MAIN RESULTS

Mortality, length of stay, and total cost were measured. Age, gender, race/ethnicity, trauma status, Acute Physiology and Chronic Health Evaluation III score, and physician utilization of the eICU were included as covariates.Included in the analysis were 4088 patients (1371 at baseline, 1287 in eICU wave one, and 1430 in eICU wave two). The eICU did not have a significant effect on ICU/non-ICU/total mortality or hospital length of stay. ICU length of stay increased over time and was associated with higher physician utilization of the eICU. Although total hospital costs increased over time, the rate of increase was steeper for those patients whose physicians permitted only a low level of eICU involvement.

CONCLUSIONS

In our study of >4000 patients representing two community hospitals, we did not find a reduction in mortality, length of stay, or hospital cost attributable to the introduction of the eICU.