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Systematic Reviews
Published in: Systematic Reviews 1/2016

Open Access 01-12-2016 | Research

Telemedicine with clinical decision support for critical care: a systematic review

Authors: Nicola Mackintosh, Marius Terblanche, Ritesh Maharaj, Andreas Xyrichis, Karen Franklin, Jamie Keddie, Emily Larkins, Anna Maslen, James Skinner, Samuel Newman, Joana Hiew De Sousa Magalhaes, Jane Sandall

Published in: Systematic Reviews | Issue 1/2016

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Abstract

Background

Telemedicine applications aim to address variance in clinical outcomes and increase access to specialist expertise. Despite widespread implementation, there is little robust evidence about cost-effectiveness, clinical benefits, and impact on quality and safety of critical care telemedicine. The primary objective was to determine the impact of critical care telemedicine (with clinical decision support available 24/7) on intensive care unit (ICU) and hospital mortality and length of stay in adults and children. The secondary objectives included staff and patient experience, costs, protocol adherence, and adverse events.

Methods

Data sources included MEDLINE, EMBASE, CINAHL, Cochrane Library databases, Health Technology Assessment Database, Web of Science, OpenGrey, OpenDOAR, and the HMIC through to December 2015. Randomised controlled trials and quasi-experimental studies were eligible for inclusion. Eligible studies reported on differences between groups using the telemedicine intervention and standard care. Two review authors screened abstracts and assessed potentially eligible studies using Cochrane guidance.

Results

Two controlled before-after studies met the inclusion criteria. Both were assessed as high risk of bias. Meta-analysis was not possible as we were unable to disaggregate data between the two studies. One study used a non-randomised stepped-wedge design in seven ICUs. Hospital mortality was the primary outcome which showed a reduction from 13.6 % (CI, 11.9–15.4 %) to 11.8 % (CI, 10.9–12.8 %) during the intervention period with an adjusted odds ratio (OR) of 0.40 (95 % CI, 0.31–0.52; p = .005). The second study used a non-randomised, unblinded, pre-/post-assessment of telemedicine interventions in 56 adult ICUs. Hospital mortality (primary outcome) reduced from 11 to 10 % (adjusted hazard ratio (HR) = 0.84; CI, 0.78–0.89; p = <.001).

Conclusions

This review highlights the poor methodological quality of most studies investigating critical care telemedicine. The results of the two included studies showed a reduction in hospital mortality in patients receiving the intervention. Further multi-site randomised controlled trials or quasi-experimental studies with accompanying process evaluations are urgently needed to determine effectiveness, implementation, and associated costs.

Trial registration

Appendix
Available only for authorised users
Footnotes
1
Refers to a physician with intensive care certification.
 
2
Prescribing providers are physicians, or critical care trained nurse practitioners, or physician assistants.
 
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Metadata
Title
Telemedicine with clinical decision support for critical care: a systematic review
Authors
Nicola Mackintosh
Marius Terblanche
Ritesh Maharaj
Andreas Xyrichis
Karen Franklin
Jamie Keddie
Emily Larkins
Anna Maslen
James Skinner
Samuel Newman
Joana Hiew De Sousa Magalhaes
Jane Sandall
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2016
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-016-0357-7

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