Multidisciplinary Telemedicine Intervention for ICU Recovery

A randomised controlled trial evaluated the feasibility of delivering a multidisciplinary telemedicine ICU recovery clinic for survivors of critical illness and of collecting long-term recovery outcomes. Survivors of sepsis and acute respiratory distress syndrome (ARDS) frequently develop post-intensive care syndrome (PICS), which encompasses persistent cognitive, psychological, physical, social and quality-of-life impairments that may last months or years after hospital discharge. Although multidisciplinary ICU recovery clinics have been established to address these problems, attendance remains poor because of barriers including travel, disability, financial constraints, competing healthcare demands and caregiver burden. Telemedicine has the potential to improve access by removing geographical and logistical barriers, but its feasibility and impact on recovery remain uncertain.

The TelePORT study was a two-site pilot feasibility randomised controlled trial conducted at an academic medical centre and a regional community medical centre in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or ARDS who were expected to survive to discharge were eligible. Participants were randomised in a 1:1 ratio to either a telemedicine ICU recovery clinic or standard post-discharge care. Patients with significant cognitive or psychiatric disorders preventing independent living, those without computer or internet access, non-English speakers, or those requiring specialised multidisciplinary follow-up for other conditions were excluded.

All participants received written information describing PICS. Those assigned to the intervention underwent two one-hour telemedicine appointments at approximately three weeks and three months after hospital discharge. Visits were conducted through a secure web-based patient portal and involved a multidisciplinary team comprising an ICU physician or nurse practitioner, pharmacist and psychologist. The intervention included review of the hospital course, focused medical assessment, medication reconciliation, cognitive and psychological screening, brief psychotherapy, patient education, treatment planning, referral to appropriate services and coordination of ongoing care. Participants in the control group received usual post-discharge care as determined by their treating clinicians, without structured ICU recovery clinic visits.

Assessments were performed before hospital discharge or shortly afterwards to establish pre-hospital function, followed by evaluations at one week and six months after discharge. Outcome measures examined cognitive, mental and physical health using validated assessment tools. The study also evaluated implementation outcomes, including recruitment, retention, telemedicine attendance, clinician fidelity and participant ratings of acceptability, appropriateness and feasibility.

Between December 2019 and December 2021, 1,108 patients were screened. Following exclusions and refusals, 91 participants were randomised, with 46 allocated to telemedicine and 45 to standard care. The median participant age was 57 years, approximately half were male, and over 90% were White. Most participants had sepsis as their primary diagnosis, with a median ICU stay of five days. During follow-up, attrition occurred because of death, withdrawal and loss to follow-up.

Among participants allocated to telemedicine, 57.5% attended at least one virtual clinic visit. Attendance reached 55% at the three-week visit and 42.5% at three months. Attendance differed substantially between sites, with considerably higher participation at the academic medical centre than the regional community hospital. Many community participants lacked established access to the patient portal required for the intervention, highlighting digital barriers despite the intended accessibility of telemedicine.

Despite only moderate patient engagement, clinician fidelity to the intervention was consistently high. Pharmacists participated in every scheduled clinic, while nurse practitioners, psychologists and ICU physicians attended the vast majority of appointments. Visits covered comprehensive recovery issues, including medication management, physical recovery, mental health, cognitive concerns, rehabilitation needs and case management.

Participants who attended telemedicine appointments rated the intervention highly for acceptability, appropriateness and feasibility. Ratings were similarly favourable among participants receiving standard care, suggesting that telemedicine was viewed as a credible and practical method of delivering multidisciplinary post-ICU care. Previous qualitative findings referenced by the authors indicated that participants appreciated the convenience, comprehensive nature and caregiver involvement made possible by virtual appointments.

Exploratory analyses of recovery outcomes demonstrated that cognitive, mental and physical health generally improved between one week and six months after discharge in both study groups. However, no statistically significant differences were observed between the telemedicine and standard care groups across any PICS domain. Because the study was designed to assess feasibility rather than efficacy, it was not powered to detect treatment effects. Nevertheless, analyses identified several factors associated with poorer recovery trajectories, including worse pre-hospital cognitive function, greater frailty and higher perceived stress before illness. These findings suggest that individual patient characteristics may influence long-term recovery more strongly than the intervention itself and could help identify patients who would benefit most from targeted post-ICU support.

Overall, the TelePORT trial demonstrated that a multidisciplinary telemedicine ICU recovery clinic is feasible to deliver, achieves high clinician adherence and is well accepted by participating patients. Although no significant improvements in long-term recovery outcomes were observed compared with standard care, the study provides valuable information for designing larger trials. Future research should focus on improving patient engagement, overcoming digital barriers, recruiting more diverse populations and identifying high-risk survivors who may benefit most from tailored telemedicine-based ICU recovery services.

Source: Critical Care
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