• Mario V Fusaro, Christian Becker, and Corey Scurlock.
• eHealth Center, Westchester Medical Center Health Network, Valhalla, NY.
• Crit. Care Med. 2019 Apr 1; 47 (4): 501-507.

ObjectivesPast studies have examined numerous components of tele-ICU care to decipher which elements increase patient and institutional benefit. These factors include review of the patient chart within 1 hour, frequent collaborative data reviews, mechanisms for rapid laboratory/alert review, and interdisciplinary rounds. Previous meta-analyses have found an overall ICU mortality benefit implementing tele-ICU, however, subgroup analyses found few differences. The purpose of this systematic review and meta-analysis was to explore the effect of tele-ICU implementation with regard to ICU mortality and explore subgroup differences via observed and predicted mortality.Data SourcesWe searched PubMed, Cochrane Library, Embase, and European Society of Intensive Care Medicine for articles related to tele-ICU from inception to September 18, 2018.Study SelectionWe included all trials meeting inclusion criteria which looked at the effect of tele-ICU implementation on ICU mortality.Data ExtractionWe abstracted study characteristics, patient characteristics, severity of illness scores, and ICU mortality rates.Data SynthesisWe included 13 studies from 2,766 abstracts identified from our search strategy. The before-after tele-ICU implementation pooled odds ratio for overall ICU mortality was 0.75 (95% CI, 0.65-0.88; p < 0.001). In subgroup analysis, the pooled odds ratio for ICU mortality between the greater than 1 versus less than 1 observed to predicted mortality ratios was 0.64 (95% CI, 0.52-0.77; p < 0.001) and 0.98 (95% CI, 0.81-1.18; p = 0.81), respectively. Test for interaction was significant (p = 0.002).ConclusionsAfter evaluating all included studies, tele-ICU implementation was associated with an overall reduction in ICU mortality. Subgroup analysis suggests that publications exhibiting observed to predicted ICU mortality ratios of greater than 1 before tele-ICU implementation was associated with a reduction in ICU mortality after tele-ICU implementation. No significant ICU mortality reduction was noted in the subgroup of observed to predicted ICU mortality ratio less than 1 before tele-ICU implementation. Future studies should confirm this finding using patient-level data.

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