RCT: Tele-ICU Intervention Did Not Significantly Reduce ICU Length of Stay in Critically Ill Patients
10 Oct, 2024 | 17:40h | UTCBackground: Telemedicine in critical care, particularly through tele-ICU interventions, has gained traction as a potential solution to the global shortage of intensivists. These systems, which include remote intensivist-led care, have shown promise in improving outcomes, but robust evidence from randomized clinical trials is lacking. The TELESCOPE trial was conducted to assess whether daily remote multidisciplinary rounds combined with monthly audit and feedback meetings could reduce ICU length of stay (LOS) compared with standard care.
Objective: The primary objective of the TELESCOPE trial was to determine if a tele-ICU intervention, involving remote daily multidisciplinary rounds and monthly performance audits led by a board-certified intensivist, could reduce ICU LOS compared to usual care.
Methods: This was a cluster randomized clinical trial involving 30 general ICUs in Brazil, enrolling all consecutive adult patients admitted between June 2019 and April 2021. A total of 17,024 patients were included, with 15 ICUs receiving the tele-ICU intervention and 15 receiving standard care. The intervention consisted of daily remote rounds led by an intensivist, monthly audit meetings, and the provision of evidence-based protocols. The primary outcome was ICU LOS, and secondary outcomes included hospital mortality, ICU efficiency, and various infection rates.
Results: There was no statistically significant difference in ICU LOS between the intervention and control groups (mean LOS: 8.1 days in the tele-ICU group vs. 7.1 days in the usual care group; percentage change, 8.2%; 95% CI, −5.4% to 23.8%; P = .24). Hospital mortality was also similar (41.6% vs. 40.2%; odds ratio, 0.93; 95% CI, 0.78-1.12). No significant differences were found in secondary outcomes, including rates of central line-associated bloodstream infections, ventilator-associated events, or ventilator-free days at 28 days.
Conclusions: The tele-ICU intervention did not reduce ICU LOS in critically ill patients. The lack of observed benefit may be due to suboptimal implementation, variable adherence by local teams, and the high severity of illness in the patient population.
Implications for Practice: While tele-ICU models hold potential, this study suggests that remote intensivist-led care, as implemented in the TELESCOPE trial, may not be sufficient to improve outcomes in high-resource ICU settings with critically ill patients.
Study Strengths and Limitations: The study’s strengths include its pragmatic design, the large number of patients enrolled, and its reflection of real-world ICU settings. However, limitations include the unblinded nature of the trial, suboptimal adherence to the tele-ICU protocol in some centers, and the strain on ICU resources during the COVID-19 pandemic, which may have affected the trial’s outcomes.
Future Research: Further studies should explore how tele-ICU interventions can be optimized, with a focus on identifying the ICU environments and patient populations most likely to benefit. Trials should also address potential barriers to effective implementation, such as staff engagement and local resource constraints.