CHEST Guidelines-Leveraging-ICU-Telemedicine-to-Reduce-Low-Value-In

Leveraging-ICU-Telemedicine-to-Reduce-Low-Value-In

Pdf Summary

In a study published in CHEST, Fortis and colleagues explored the impact of ICU telemedicine on interhospital transfer rates for patients in Veterans Affairs ICUs, noting an association with reduced transfer rates and increased adjusted 30-day mortality among transferred patients. Stephanie Parks Taylor, MD, and Brice Taylor, MD, responded, discussing the significance of distinguishing between high-value and low-value transfers. They highlighted that while lower transfer rates may ensure the sickest patients receive necessary care, the study's findings could also reflect appropriate triage enabled by telemedicine. High-value transfers improve patient outcomes, while low-value, or futile, transfers may burden both healthcare systems and families without benefiting the patient, particularly in end-of-life situations.<br /><br />The Taylors suggested that ICU telemedicine could prevent unnecessary transfers by retaining patients in local ICUs through telemedicine support and reducing futile transfers where end-of-life care might be more appropriate. They questioned whether additional data, such as care limitation or comfort-focused care orders at destination hospitals, could shed light on the nature of these transfers and their association with telemedicine.<br /><br />In their response, Fortis and colleagues acknowledged the concerns raised by the Taylors, suggesting that telemedicine likely narrowed transfers to the sickest patients by retaining less critical ones. They emphasized the importance of appropriate interhospital transfers that can positively alter patient outcomes and highlighted the potential role of telemedicine in providing palliative care, even remotely. The authors recognized the challenges in managing end-of-life care at resource-limited ICUs and reinforced telemedicine's role in facilitating these discussions, thereby potentially reducing unnecessary transfers.

Keywords

ICU telemedicine

interhospital transfers

Veterans Affairs

30-day mortality

high-value transfers

low-value transfers

end-of-life care

palliative care

resource-limited ICUs

patient outcomes