Efficacy of Tele-Critical Care in Managing Critically Ill Patients With COVID-19: Analysis of Outcomes From an Integrated Health System

Abstract

Background:

The implications of splitting medical management and advanced procedural care are unique to critical care medicine. As tele-critical care adoption accelerates, examining the equivalence between in-person intensivist care and tele-intensivist staffing is needed. We sought to examine the equivalence of patient outcomes associated with tele-intensivist and in-person intensivist care of critically ill patients with COVID-19.

Methods:

In this retrospective multi-center cohort study, 1,885 consecutive critical care hospitalizations of subjects with COVID-19 receiving tele-intensivist or in-person intensivist care at 5 hospitals in Texas participating in the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study COVID-19 registry were included. The main outcomes were mortality, length of stay, and duration of invasive ventilation.

Results:

Of the 1,885 ICU admissions, 491 (26%) were managed in 4 hospitals with tele-intensivist staffing and compared with 1,394 (74%) ICU admissions managed by the same intensivists via in-person staffing (1 hospital). Propensity score matching for controlled comparison of tele-intensivist and in-person intensivist groups revealed no difference in ICU or in-hospital mortality, length of stay, or duration of invasive ventilation.

Conclusions:

Mortality, length of stay, and duration of invasive ventilation of subjects receiving tele-intensivist care were similar to subjects in the same healthcare system receiving in-person intensivist care.