Clinical practice impact of multiple parameter telemetry in trauma intensive care unit patients

Purpose: To determine if the availability of Multiple Parameter Telemetry influences physician decision to admit or discharge patients in a Trauma Intensive Care Unit (TICU). Multiple Parameter Telemetry (MPT) is a monitoring device that simultaneously transmits EKG, noninvasive blood pressure, and pulse oximetry signals to a remote station. Methods: The study protocol was approved by the University of Miami Medical Sciences Subcommittee for the Protection of Human Subjects. We prospectively studied 228 consecutive patients who were presented for admission to the TICU. Patients were randomized to have MPT monitoring available upon discharge to the ward or to a control group. The decisions to admit or discharge patients from the TICU and their medical management was determined by the ICU and surgical teams and not by the study protocol. The primary endpoints recorded in both groups were TICU length of stay, total hospital bill, and TICU readmission. In addition age, sex, and APACHE II score were recorded. Results: Out of 228 patients studied, 111 were randomized to the MPT group and 117 to the control group. There were no significant differences between groups with regard to age, sex, and APACHE II admission score. TICU length of stay, total hospital bill, and incidence of readmission to TICU were also not significantly different between groups. When stratified by age, patients in the control group who were older than 65 spent significantly more days in the TICU than younger patients in the same group (*p<0.05) (Table). However, this was not statistically significant in the MPT group. Control Group MPT Group Age 1-2days 3+days 1-2days 3+days <65 41(45%) 51(55%) 45(48%) 49(52%) >=65 5(22%) 18(78%)*5(33%) 10(67%) Conclusions: Physicians tend to discharge older patients earlier from the TICU when MPT is available. Use of MPT was not associated with an increase in the total hospital bill or in the frequency of TICU readmission. A larger prospective study is needed to definitely establish if MPT decreases TICU length of stay in older patients.