Hospitals with tele-critical care had fewer transfers ending in death within a day

Design

Nationwide retrospective cohort, Medicare claims linked to hospital survey data

Population

2,140,919 Medicare ICU hospitalisations, 2022–2023

Primary outcome

Interhospital ICU transfer

Effect

Transfer aOR 1.08 (1.01–1.14); death or hospice within 1 day 4.6% vs 6.6%, aOR 0.86 (0.76–0.97)

This nationwide retrospective cohort linked 2021–2023 Medicare claims to US hospital survey data, covering 2,140,919 ICU stays, a third at 1,066 hospitals with tele-critical care. The main outcome was interhospital ICU transfer.

Absolute transfer rates were similar (2.5% with tele-critical care, 3.0% without), but after adjustment tele-critical care was associated with slightly higher odds of transfer (aOR 1.08, 1.01–1.14). In exploratory analyses, patients transferred from those hospitals were sicker, yet less often died or went to hospice within a day of arriving (4.6% vs 6.6%; aOR 0.86) and slightly more often went home within two days.

The interpretation is about selection. Remote intensivist input seems to steer transfer towards patients who can benefit and away from those who are dying or who could stay put. For smaller hospitals, tele-critical care looks less like a way to avoid transfers and more like a way to choose them better. This is observational and US-specific.

• Before transferring a critically ill patient, ask whether the receiving unit can offer something that changes the outcome.
• A transfer that ends in death or hospice within a day is usually one that should not have happened.
• Remote intensivist support may improve which patients are sent, not only how many.
• Discuss goals of care before transfer for patients who may be dying.

Why it matters

It reframes tele-critical care as a tool for better transfer decisions, not just fewer of them.

Don't overread it

Hospitals that adopt tele-critical care may differ in other ways that also improve transfer decisions.

The statistics, in plain English

An adjusted odds ratio of 1.08 is a very small increase in transfer odds, statistically detectable only because of the huge sample. The more meaningful finding is the drop from 6.6% to 4.6% in transfers ending within a day in death or hospice, though it comes from exploratory analysis.

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