Research involving IDOR and international centers examines the effects of multidisciplinary remote care in Brazilian ICUs 

Telemedicine has become increasingly adopted in Intensive Care Units (ICUs) to address the shortage of intensivists and broaden multidisciplinary support for patients. Recently published in the Journal of the American Medical Association (JAMA), a study involving the D’Or Institute for Research and Education (IDOR) and research centers in Brazil, the United Kingdom, Australia, and Spain examined the impact of a remote telecare intervention to determine if this model could reduce ICU length of stay. 

Critical care relies on a multidisciplinary approach, bringing together specialists from diverse fields to optimize diagnostics and treatment. In ICU settings, the presence of intensivists and other trained professionals is essential for ensuring the best clinical outcomes. However, the shortage of these specialists, especially outside urban centers, poses a major global public health challenge.  

Telemedicine offers a potential solution by extending the expertise of these professionals to more remote areas, enabling ICUs to receive remote support from various specialists. Yet, despite its promise, the outcomes observed have been mixed, underscoring the need for further research to better understand its effectiveness. 

The TELESCOPE Study: Examining Telemedicine in Brazilian ICUs   

To explore telemedicine’s potential, research centers developed the TELE-critical Care verSus usual Care on ICU PErformance (TELESCOPE) study. The primary aim was to assess whether a structured telecare intervention could reduce ICU length of stay in Brazilian units. This intervention involved daily multidisciplinary rounds led by a remote intensivist, along with monthly performance reviews via telemedicine. 

Conducted across 30 public ICUs in Brazil’s diverse geographic regions, the study took place from June 2019 to April 2021, involving 17,024 adult patients. During the intervention, certified intensivists conducted daily multidisciplinary rounds, discussing diagnostic hypotheses and treatment plans with the on-site team. Additionally, remote intensivists joined virtual monthly meetings with local leaders to review ICU performance indicators. The intervention was supported by 19 clinical protocols provided in both text and video formats to encourage evidence-based practices. 

Analyzing Study Data and Challenges in Telemedicine Implementation 

When comparing results to data from ICUs following standard procedures (without telemedicine), the researchers observed no significant difference in length of stay between the telemedicine group and the usual care group. The adjusted average length of stay was 8.1 days in the telemedicine group and 7.1 days in the standard care group. Other outcomes, such as mortality rates and incidence of device-associated infections, also showed no meaningful differences. 

The authors suggest several factors that may explain these neutral findings. First, adherence to the intervention varied among participating ICUs, and the involvement of local teams is essential for telecare’s effectiveness. Furthermore, the ICUs included had diverse patient profiles, staffing, and resources, which may hinder the uniform implementation of remote interventions. Another factor is that part of the study occurred during the covid-19 pandemic, when the combination of severely ill patients and a shortage of resources and staff in some ICUs suggests that the telemedicine model tested may not be robust enough to meet such complex demands. 

The TELESCOPE study highlighted both the potential and challenges of implementing telemedicine in ICUs. While this tool shows promise in addressing the shortage of specialists in remote areas, its effectiveness depends on local infrastructure and team engagement. The results suggest that telemedicine models need to be tailored to the specific needs of each ICU in order to truly enhance critical patient care. These findings contribute to a broader understanding of telemedicine’s role and underscore the need for customized approaches to meet the realities of different units.