Multidisciplinary telemedicine intervention for ICU recovery: the TelePORT feasibility randomized trial

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Abstract
Survivors of critical illness commonly experience post-intensive care syndrome (PICS), including cognitive, mental health, physical, quality-of-life, and social impairments after discharge. Telemedicine may improve access to post-ICU recovery clinic care, but its feasibility and effect on recovery outcomes remain unclear. We evaluated the feasibility of a multidisciplinary telemedicine post-ICU recovery clinic and collecting 6-month outcome data. We conducted a two-site pilot feasibility randomized controlled trial at an academic medical center and regional community medical center in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or acute respiratory distress syndrome were randomized 1:1 to telemedicine ICU recovery clinic visits or standard care. The intervention included two multidisciplinary visits at 3 weeks and 3 months after hospital discharge; participants accessed visits via a secure web-based personal health portal, where they videoconferenced simultaneously with an ICU clinician, pharmacist, and psychologist. Participants in the standard of care group received usual post-discharge care. Feasibility outcomes included enrollment, retention, attendance, clinician fidelity, and participant ratings of acceptability, appropriateness, and feasibility. Exploratory outcomes included cognitive, mental health (i.e., depression, anxiety, PTSD), and physical health (i.e., activities of daily living, independent activities of daily living) composite scores measured at 1 week and 6 months after hospital discharge. Of 1,108 screened patients, 91 were randomized (telemedicine, n = 46; standard care, n = 45). Among 83 participants completing the 1-week assessment, median age was 56 years, 51% were male, and 91% were White. In the telemedicine arm, 23 participants (57.5%) attended at least one visit; attendance was 55% at 3 weeks and 42.5% at 3 months among eligible participants. Primary 6-month outcome assessment was completed by 31 participants in each group (67%). Clinician participation fidelity was high, and telemedicine attendees reported favorable acceptability, appropriateness, and feasibility ratings. Exploratory analyses of PICS composite outcomes did not differ significantly between groups. A multidisciplinary telemedicine post-ICU recovery clinic and associated trial procedures were feasible, with high clinician fidelity and favorable participant ratings. Larger trials are needed to explore engagement strategies and evaluate effectiveness on long-term recovery outcomes, prioritizing inclusion of more diverse and historically underrepresented populations. NCT03926533 (posted 4/24/2019).
Funding Information
  • National Heart, Lung, and Blood Institute (K12HL137943)
  • National Institute on Aging (R01AG077644)
  • American Association of Critical-Care Nurses
  • Vanderbilt University (Discovery Grant)

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