Table 1 Characteristics of included studies
Source | Country | Participants (intervention/control) | Study design | Telemedicine (communication approach) | Collaboration team | Key results |
|---|---|---|---|---|---|---|
Breslow11 | U.S.A. | Critical illness (744/1396) | Before-after | Centralized eICU (Communication system) | On-site ICU staff + Off-site eICU staff | Reduced hospital mortality from 12.9% to 9.4% (RR 0.73, p < 0.05). 16% reduction in ICU length of stay; decreased variable costs per case by 25%. |
Forni40 | U.S.A. | Mechanical ventilation in ICU (1073/1079) | Before-after | Tele-ICU pharmacist (Communication system + phone call + email) | Tele-ICU and daytime pharmacists + Bedside ICU team | Higher daily sedation interruption compliance (45%–54%, p < 0.0001). Increased sedation-related interventions (0.9 vs. 4.4 per 100 patient-days, p < 0.0001). |
Chen11 | China | STEMI (51/54) | Before-after | Tele-ECG triage system (Email + phone message) | On-call interventional cardiologist + ED triage nurse + Cath lab team | Door-to-balloon time improved from a median of 125 min to 86 min. Proportion achieving <90-min door-to-balloon rose from 44% to 76%. |
Evans26 | U.S.A. | Physiological deterioration (6289/6592) | Before-after | A real-time, automated early warning system (Email + pager + communication system) | MET Risk Committee + Charge nurses on floors + Floor nurses + Physicians/hospitalists | Significant increase in appropriate MET calls. Mortality on floors with older/sicker patients decreased from 3.7% to 2.6% (p = 0.044). |
Umscheid41 | U.S.A. | Sepsis (545/595) | Before-after | A real-time, EHR-integrated sepsis detection tool (Text page + EHR note) | Covering provider + Bedside nurse + Rapid response service | Earlier antibiotic and fluid interventions; more frequent lactate/blood culture orders. Improved time to ICU transfer (not statistically significant). |
Wilson19 | U.S.A. | AKI (1201/1192) | RCT | A one-time automated text-based alert system (Text page + email + website) | Covering provider + Unit-based pharmacist + Nephrology | No significant improvement in creatinine, dialysis, mortality. Slight increase in dialysis and renal consultation in a surgical ward subgroup. |
Kim42 | South Korea | ID (678/648) | Before-after | EMR pop-up alerts and automated ID consult prompts (EHR-based communication) | ID service + Microbiology lab + Attending physicians | Improved rates of effective (87.8% → 94.4%), optimal (64.4% → 81.4%), and de-escalated (10% → 18.6%) therapy at 24 h. |
Subbe33 | U.K. | Physiological deterioration (2263/2139) | Before-after | An automated vital sign monitoring and alert (Pager + phone call) | Ward nurses and + RRT/MET | RRT notifications increased from 405 to 524. Reduced hospital mortality (173 to 147 events, p = 0.042). Cardiac arrests dropped significantly (14 to 2 events, p = 0.002). Lower ICU mortality (45% to 24%, p = 0.04). |
Park6 | South Korea | AKI (1309/1884) | Before-after | Electronic AKI alert system providing pop-up notifications for automatic nephrology consultation. (EHR-based communication) | Hospital-wide services + Nephrology division | 40% reduction in overlooked AKI cases. ~6x higher odds of early nephrology consultation post-implementation. Lower odds of severe AKI (stage 2–3) and faster creatinine recovery. |
Djelic43 | Canada | ID (113/40) | Before-after | Lab-based automatic ID alert system (Unclear) | ID specialist + Primary clinicians/surgeons | ID consultation rate rose from 70% to 100%. Lower ICU transfer rate (38% to 16%). |
Connell27 | U.K. | AKI (480/994) | Before-after | “Streams” mobile application delivers real-time alerts (Mobile communication system) | Nephrology service + Patient at Risk and Resuscitation Team (PARRT) | No significant change in renal function recovery, but potential cost reductions. Trend toward faster recognition of AKI and more consistent follow-up. |
Kadar44 | U.S.A. | Critical illness (74/99) | Retrospective cohort study | eICU for ED “ICU boarders” (Communication system) | Off-site eICU staff + On-site ED staff | In-hospital mortality significantly lower (5.4% vs. 20%; adjusted OR 0.20). 36% of eICU-managed patients were “downgraded” to non-ICU care before a formal ICU transfer. |
Meyer45 | U.S.A. | Parenteral nutrition(218/202) | Before-after | A “virtual” nutrition support team (NST) (Verbal communication + EHR charting + EHR tools) | NST + Bedside teams | Improved parenteral nutrition appropriateness from 58.9% to 97.2% (p < 0.001). Better glucose control: 83.5% vs. 62.2% (p < 0.001). |
Connell28 | U.K. | AKI (439/766) | Before-after | “Streams” mobile application delivers real-time alerts (Mobile communication system) | Nephrologists + Frontline ward/ED clinicians | Serum creatinine recovery showed no significant step change. Improved process measures and time to AKI recognition/treatment31. |
Escobar46 | U.S.A. | Physiological deterioration (13274/23797) | Before-after | The Advance Alert Monitor (AAM) (Unclear) | Remote nurses stationed off-site + Rapid-response nurses + Beside staff. | 30-day mortality after an alert decreased (RR 0.84, p < 0.001). Reduced ICU admissions and shorter hospital LOS among high-risk patients. |
Heller12 | Germany | Physiological deterioration (1936/1896) | Before-after | Automated monitoring and alert system (Communication system + text message +) | Besides staff + MET + Anesthesiologists and critical care staff | Cardiac arrests decreased from 5.3 to 2.1 per 1000 admissions. Unplanned ICU admissions dropped from 3.6% to 3.0%. |
Hassan47 | U.S.A. | LVO (15/23) | Before-after | AI-based LVO detection software (Viz.ai) (Communication software) | PSC stroke/ED/radiology staff + On-call endovascular/neurointerventional team | PSC-to-CSC transfer times decreased (median 132.5 to 110 min, p = 0.047). CTA-to-groin puncture interval dropped from 216 to 127 min (p = 0.026). Overall hospital LOS declined (9.7 to 7.2 days, p = 0.032). |
Morey48 | U.S.A. | LVO (26/29) | Before-after | AI-based LVO detection software (Viz.ai) (Communication software) | ED physicians + Neuroendovascular team | Door-to-neuroendovascular team notification time dropped from 40 min to 25 min post-implementation. |
Oseran24 | U.S.A. | Type 2 DM (130/130) | RCT | Unsolicited e-Consult triggered by elevated HbA1c (EHR charting + EHR note) | Endocrinologists + Primary care physicians | No significant difference in mean HbA1c reduction at 6, 12, or 18 months. |
Hassan23 | U.S.A. | LVO (102/86) | Before-after | AI-based LVO detection software (Viz.ai) (Communication software) | Stroke Neurologists+ Neurointerventional Specialists + ED physicians + Radiologists+ Catheterization Lab Teams | Significant reduction in door-in to puncture time (~86.7 min on average post-AI). Higher reperfusion rates (modified TICI 2B-3) post-implementation. |
Dee14 | Australia | STEMI (46/77) | RCT | Automated text message-triggered diagnosis support service (Communication system + text message + phone call) | MORACS nurses + Local rural ED physicians + Tertiary referral cardiologists | Missed STEMI diagnoses dropped from 35% to 0%. Reperfusion rate among eligible patients: 100% (MORACS) vs. 64% (usual care). |
Kaur49 | U.S.A. | Post-extubation (116/85) | RCT | Automated continuous monitoring alert for respiratory status (EHR-based communication + pager) | Respiratory therapists + Bedsides physicians and nurses | No significant difference in reintubation rates (9.5% vs. 16.5%) or ICU costs. RT time on assessments/ therapies was lower in the automated alert group. |
Balshi50 | Saudi Arabia | Physiological deterioration (2151/2346) | Before-after | Automated patients monitoring and RRT notifications (Communication system) | RRT + Ward nurses | Reduced CPR incidence from 3.3% to 1.95%. Increased CPR success rate (59.5% vs. 38.5%). Hospital mortality decreased from 5.4% to 4%. |
Gaieski17 | U.S.A. | Sepsis (1233/258) | Before-after | An end-to-end tele-sepsis system (Communication system) | Off-site sepsis consultants + On-site ED teams | SEP-1 compliance rose from 68.4% to 78.3% (p = 0.002). Improved performance on lactate, blood culture, and timely antibiotic metrics. |
Weis16 | Germany | ID (177/209) | RCT | Unsolicited telephone-based ID consult (Phone call + fax) | ID experts + Local hospital clinicians | No improvement in 30-day mortality. No difference in 90-day mortality, readmissions, or recurrence. Some increases in QI adherence |
Martinez18 | U.S.A. | LVO (103/140) | RCT | AI-based LVO detection software (Viz.ai) (Communication system) | Neurologists + Interventional neuroradiologists + ED physicians + Radiologists + nurses | Reduced door-to-groin times by ~11 min (95% CI: −18.2 to −4.2). Time from CT scan start to EVT start fell by ~9.8 min (95% CI: −16.9 to −2.6). |
King31 | U.S.A. | Anesthesia (12980/13274) | RCT | “Anesthesiology Control Tower” (ACT) (EHR-integrated messaging tools + phone) | Off-site ACT team + OR anesthesiology team | Slight increase in intraoperative glucose checks among diabetic patients. No changes in postoperative mortality, readmission, or acute kidney injury. |
Judson25 | U.S.A. | Hyponatremia (38/24) | RCT | Targeted Automatic e-Consult (TACo) (EHR charting + EHR note + pager) | Nephrologist + Primary medicine teams | 78% of physicians reported that the e-consults changed management. 68% of flagged patients received beneficial recommendations. |
King32 | U.S.A. | Anesthesia (35302/36625) | RCT | “Anesthesiology Control Tower” (ACT) (EHR-integrated messaging tools + phone) | Off-site ACT team + OR anesthesiology team | No significant difference in postoperative outcomes between telemedicine-supported vs. usual care. |
