Telehealth did not reduce death risk linked to mechanical ventilation

Availability of telehealth-based critical care did not improve outcomes among patients receiving invasive mechanical ventilation, a new study reveals.

Published in the Journal of Critical Care, the study assessed whether the availability of tele-critical care affects outcomes among mechanically ventilated patients. The study authors note that invasive mechanical ventilation is among the most common and high-risk interventions for acute respiratory failure patients in the intensive care unit (ICU). However, many hospitals do not have in-person access to board-certified critical care physicians who can help improve outcomes among mechanically ventilated patients.

Telehealth can support critical care access by connecting onsite care teams to critical care physicians. Telehealth-based critical care models vary, ranging from continuous care models with constant patient oversight to episodic care models with periodic review of patient data. While previous research shows these models improve the quality of care in the ICU, it is unclear if they enhance outcomes among patients receiving invasive mechanical ventilation.

Thus, researchers from Washington University in St. Louis School of Medicine investigated whether hospital-level availability of telehealth-based critical care was associated with improved in-hospital mortality among mechanically ventilated patients in the ICU. They conducted a cross-sectional study of 66,522 adults who received invasive mechanical ventilation for non-postoperative acute respiratory failure at 318 hospitals in New York, Massachusetts, Maryland, and Florida in 2018. They determined hospital-level availability of telehealth-based critical care from the 2018 American Hospital Association Annual Survey.

The study’s primary outcome was in-hospital mortality, and secondary outcomes included the composite of tracheostomy or reintubation and duration of invasive mechanical ventilation.

The researchers found that 20,270 of the 66,522 patients (30.5 percent) were admitted to 89 hospitals where telehealth-based critical care was available. The other 46,252 (69.5 percent) received care at hospitals where telehealth-based critical care was unavailable.

There was no difference in the likelihood of in-hospital mortality between patients in both groups. There was also no difference in the composite of tracheostomy or reintubation and duration of mechanical ventilation.

Additionally, there was no difference in outcomes among the subgroup of patients with acute respiratory distress syndrome at hospitals with and without telehealth-based critical care availability.

Thus, researchers concluded that “hospital-level availability of TCC [telehealth-based critical care] was not associated with reduced rates of in-hospital mortality, the composite of tracheostomy or reintubation, or decreased duration of mechanical ventilation.”

Even though telehealth-based critical care did not move the needle on outcomes for patients receiving invasive mechanical ventilation, healthcare providers are turning to the model to address other critical care needs.

For instance, San Juan Regional Medical Center in Farmington, New Mexico, struck a telehealth partnership with Presbyterian Hospital's neonatal intensive care unit (NICU) team last year to expand access to high-acuity care for newborns.

Through the partnership, San Juan Regional’s clinicians engage in virtual video consultations with Presbyterian's NICU team. Not only does this enable them to glean the expertise of Presbyterian neonatologists, but the partnership also provides San Juan Regional clinicians with ongoing medical education.

"The telemedicine component…allows us to, I think, more comfortably keep babies closer to home," said Brad Scoggins, DO, pediatrician and medical director at San Juan Regional, in an interview with mHealthIntelligence. "We weren't able to [do that previously] because there was this big chasm in knowledge and experience. Not only from the physicians' standpoint but from the nurses' and respiratory therapists' [standpoint]. If [neonatologists] can literally be at the bedside with the telemedicine piece, I think that helps [our staff] feel a lot better about the quality and type of work that we're doing with babies."

In addition, Emory Healthcare expanded access to its electronic ICU to Memorial Hospital and Manor and Coffee Regional Medical Center, allowing patients at these facilities to receive critical care through remote monitoring services.

The partnership, launched in 2023, allows Emory eICU physicians and nurses to remotely monitor patients at Memorial Hospital and Manor and Coffee Regional Medical Center. Further, Emory intensivists can help support on-site staff at the two hospitals through telehealth-enabled consultations.