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Graves JM, Krings JG, Buss JL, Kallogjeri D, Ofoma UR. Telemedicine critical care availability and outcomes among mechanically ventilated patients. J Crit Care 2024; 82:154782. [PMID: 38522373 DOI: 10.1016/j.jcrc.2024.154782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/08/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Telemedicine Critical Care (TCC) improves adherence to evidence based protocols associated with improved mortality among patients receiving invasive mechanical ventilation (IMV). We sought to evaluate the relationship between hospital availability of TCC and outcomes among patients receiving IMV. MATERIALS AND METHODS We performed a cross-sectional study of 66,522 adults who received IMV for non-postoperative acute respiratory failure at 318 non-federal hospitals in New York, Massachusetts, Maryland, and Florida in 2018. Hospital-level TCC availability was ascertained from the 2018 American Hospital Association Annual Survey. The primary outcome was in-hospital mortality. Secondary outcomes included the composite of tracheostomy or reintubation and duration of IMV. We used two-level hierarchical multivariable regression models to investigate the association between TCC availability and outcomes. RESULTS 20,270 (30.5%) patients were admitted into 89 TCC-available hospitals. There was no difference between TCC and non-TCC-available hospitals in mortality (odds ratio [OR] 0.94, 99% confidence interval [CI] 0.84-1.05), composite of tracheostomy or reintubation (OR 0.95 [0.82-1.11], or duration of IMV (OR 0.95 [0.83-1.09]). There was no difference in outcomes among the subgroup of patients with acute respiratory distress syndrome. CONCLUSIONS Hospital TCC availability was not associated with improved outcomes among patients receiving IMV.
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Affiliation(s)
- Jonah M Graves
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, United States of America.
| | - James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, United States of America
| | - Joanna L Buss
- Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis School of Medicine, United States of America
| | - Dorina Kallogjeri
- Department of Otolaryngology - Head & Neck Surgery, Washington University in St. Louis School of Medicine, United States of America
| | - Uchenna R Ofoma
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis School of Medicine, United States of America
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2
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O'Shea AM, Reisinger HS, Panos R, Goede M, Fortis S. Association of interactions between tele-critical care and bedside with length of stay and mortality. J Telemed Telecare 2024; 30:961-968. [PMID: 35770292 DOI: 10.1177/1357633x221107993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Substantial variation exists in telemedicine critical care (Tele-CC) effectiveness, which may be explained by heterogeneity in Tele-CC implementation and utilization. METHODS We studied inpatient intensive care unit (ICU) admissions within the Veterans Health Administration from January 2005 to September 2018. Tele-CC affiliation was based on a facility's Tele-CC go-live date. Tele-CC interaction was quantified as the monthly number of video activations, recorded in the eCaremanager® (Phillips) system, per patient days. Tele-CC affiliated facilities were propensity-score matched to facilities without Tele-CC by hospital volume and average modified APACHE scores. We examined the effect of Tele-CC affiliation and the quantity of video interactions between Tele-CC and bedside on hospital outcomes. RESULTS Comparing Tele-CC affiliated and control facilities, affiliated patients were, on average, younger (66.8 years vs 67.8 years; p < 0.001) and more likely to be rural residents (11.3% vs 6.5%; p < 0.001). Stratifying the Tele-CC affiliated facilities, facilities with frequent interactions care for more rural and sicker patients relative to facilities with infrequent interactions. Adjusting for patient demographics, facilities in the top tertile of interactions and propensity score matched control facilities were assessed; patients in ICU's with Tele-CC access experienced shorter ICU-specific lengths of stay (RR = 0.39; 95% CI = [0.23, 0.65]). However, when facilities in the bottom tertile and propensity score matched control facilities were assessed, no significant differences were noted in ICU length of stay. DISCUSSION Tele-CC interactions may occur more frequently for higher acuity patients. Increased Tele-CC interactions may improve health outcomes for the most acute and complex ICU cases.
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Affiliation(s)
- Amy Mj O'Shea
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Heather S Reisinger
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Ralph Panos
- Pulmonary, Critical Care, and Sleep Division and Cincinnati Tele-CC, Cincinnati VAMC, Cincinnati, OH, USA
- Pulmonary, Critical Care, and Sleep Division, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Matt Goede
- VA Tele-Critical. Care West, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Surgery, Division of Acute Care Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Spyridon Fortis
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA
- VA Tele-Critical. Care West, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Goudswaard L, Penny R, Edmunds J, Arnautovska U. Child Health Nurses' Acceptance and Use of a Novel Telehealth Platform: A Mixed-Method Study. Comput Inform Nurs 2024; 42:470-478. [PMID: 38512323 DOI: 10.1097/cin.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Telehealth appointments in the healthcare sector have increased since the COVID-19 pandemic, increasing patients' access to services. However, research exploring nurse perceptions of implemented telehealth services in the community sector is limited. Within the context of quality improvement, the current study aimed to understand child health nurses' acceptance and use of a novel telehealth platform using mixed methods. A total of 38 child health nurses completed an online survey that included multiple-choice questions based on an expanded Technology Acceptance Model and open-ended questions exploring barriers and facilitators to use. Results demonstrated that despite 70% of nurse users having completed less than three sessions with parents, perception and acceptance scores were high. Overall, 85% of variance in satisfaction with the platform and 46% of variance in intention to use the platform were predicted by perception scores. Three consistent themes generated from data were facilitators for use and five as barriers, which provided further understanding to findings. To ensure telehealth is adapted into routine clinical care, facilitators and barriers for implementation need to be identified and addressed. Nurses need to be engaged in implementation and ongoing maintenance to ensure the uptake and optimal use of technology within nursing care.
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Affiliation(s)
- Liselot Goudswaard
- Author Affiliations: Child and Youth Community Health Service, Children's Health Queensland Hospital and Health Service (Mrs Goudswaard, Dr Penny, and Mrs Edmunds), Brisbane; Faculty of Medicine, The University of Queensland (Mrs Goudswaard and Dr Arnautovska), South Brisbane; School of Nursing, Queensland University of Technology, Kelvin Grove (Dr Penny), Brisbane; and Metro South Addictions and Mental Health Service (Dr Arnautovska), Woolloongabba, QLD, Australia
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Richburg CE, Pesavento CM, Vastardis A, Antunez AG, Gavrila V, Cuttitta A, Nathan H, Byrnes ME, Dossett LA. Targets for De-implementation of Unnecessary Testing Before Low-Risk Surgery: A Qualitative Study. J Surg Res 2024; 293:28-36. [PMID: 37703701 DOI: 10.1016/j.jss.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Despite multispecialty recommendations to avoid routine preoperative testing before low-risk surgery, the practice remains common and de-implementation has proven difficult. The goal of this study as to elicit determinants of unnecessary testing before low-risk surgery to inform de-implementation efforts. METHODS We conducted focused ethnography at a large academic institution, including semi-structured interviews and direct observations at two preoperative evaluation clinics and one outpatient surgery center. Themes were identified through narrative thematic analysis and mapped to a comprehensive and integrated checklist of determinants of practice, the Tailored Implementation for Chronic Diseases framework (TICD). RESULTS Thirty individuals participated (surgeons, anesthesiologists, primary care physicians, physician assistants, nurses, and medical assistants). Three themes were identified: (1) Shared Values (TICD Social, Political, and Legal Factors), (2) Gaps in Knowledge (TICD Individual Health Professional Factors, Guideline Factors), and (3) Communication Breakdown (TICD Professional Interactions, Incentives and Resources, Capacity for Organizational Change). Shared Values describe core tenets expressed by all groups of clinicians, namely prioritizing patient safety and utilizing evidence-based medicine. Clinicians had Gaps in Knowledge related to existing data and preoperative testing recommendations. Communication Breakdowns within interdisciplinary teams resulted in unnecessary testing ordered to meet perceived expectations of other providers. CONCLUSIONS Clinicians have knowledge gaps related to preoperative testing recommendations and may be amenable to de-implementation efforts and educational interventions. Consensus guidelines may streamline interdisciplinary communication by clarifying interdisciplinary needs and reducing testing ordered to meet perceived expectations of other clinicians.
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Affiliation(s)
- Caroline E Richburg
- University of Michigan Medical School, Ann Arbor, Michigan; National Institute of Health Short-Term Biomedical Research Training Program, Bethesda, Maryland
| | - Cecilia M Pesavento
- University of Michigan Medical School, Ann Arbor, Michigan; National Institute of Health Short-Term Biomedical Research Training Program, Bethesda, Maryland
| | - Andrew Vastardis
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alexis G Antunez
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Valerie Gavrila
- University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Anthony Cuttitta
- University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Hari Nathan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Mary E Byrnes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
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Gonzalez M, Williams LM, Yanello K, White J, Meyer S, Powell L, Benneche KA, Knoblach C, Jacobs L, Rincon TA. Innovations in Tele-Critical Care Nursing During the COVID-19 Pandemic. AACN Adv Crit Care 2023; 34:324-333. [PMID: 38033216 DOI: 10.4037/aacnacc2023152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
For decades, tele-critical care (TCC) programs have provided expert population surveillance with standardized clinical interventions for critically ill patients. The COVID-19 pandemic created massive strains on critical care resources. For this report, standard questions were used to solicit COVID-19 pandemic workflow and service modifications from a network of TCC leaders to describe the rapid expansion of TCC-supported services during the pandemic. In this article, leaders from 7 TCC programs report on the effective use of services to support changing hospital needs during the pandemic in areas such as clinical education, personal protective equipment stewardship, expansion of virtual care, and creative staffing models, among others.
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Affiliation(s)
- Miguel Gonzalez
- Miguel Gonzalez is Nurse Manager, Tele-Critical Care & Virtual Sepsis Unit, Baptist Health South Florida, 6855 Red Road, Coral Gables, FL 33143
| | - Lisa-Mae Williams
- Lisa-Mae Williams is Operations Director, Tele-Critical Care & Virtual Sepsis Unit, Baptist Health South Florida, Coral Gables, Florida
| | - Kim Yanello
- Kim Yanello is Telehealth Product Manager, Ascension Illinois, Boilingbrook, Illinois
| | - Jason White
- Jason White is Clinical Nurse Manager, Tele-ICU, St Louis, Missouri
| | - Shelley Meyer
- Shelley Meyer is Assistant Nurse Manager, Tele-ICU, St Louis, Missouri
| | - Lillian Powell
- Lillian Powell is Administrative Director, Connected Care, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Kara A Benneche
- Kara A. Benneche is Assistant Vice President, Operations, Telehealth Services, Northwell Health, Syosset, New York
| | - Carol Knoblach
- Carol Knoblach is retired from Sutter Health Valley, Sacramento, California
| | - Lynn Jacobs
- Lynn Jacobs is retired from UW Health eICU, University of Wisconsin, Madison, Wisconsin
| | - Teresa A Rincon
- Teresa A. Rincon is Assistant Professor, UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, and Senior Telehealth Consultant, Blue Cirrus Consulting, Greenville, South Carolina
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Boyle WA, Palmer CM, Konzen L, Fritz BA, White J, Simkins M, Dieffenderfer B, Iqbal A, Bertrand J, Meyer S, Kerby P, Buckman S, Despotovic V, Kozlowski J, Crimmins Reda P, Zwir I, Gu CC, Ofoma UR. Telemedicine Critical Care-Mediated Mortality Reductions in Lower-Performing Patient Diagnosis Groups: A Prospective, Before and After Study. Crit Care Explor 2023; 5:e0979. [PMID: 37753237 PMCID: PMC10519574 DOI: 10.1097/cce.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Studies evaluating telemedicine critical care (TCC) have shown mixed results. We prospectively evaluated the impact of TCC implementation on risk-adjusted mortality among patients stratified by pre-TCC performance. DESIGN Prospective, observational, before and after study. SETTING Three adult ICUs at an academic medical center. PATIENTS A total of 2,429 patients in the pre-TCC (January to June 2016) and 12,479 patients in the post-TCC (January 2017 to June 2019) periods. INTERVENTIONS TCC implementation which included an acuity-driven workflow targeting an identified "lower-performing" patient group, defined by ICU admission in an Acute Physiology and Chronic Health Evaluation diagnoses category with a pre-TCC standardized mortality ratio (SMR) of greater than 1.5. MEASUREMENTS AND MAIN RESULTS The primary outcome was risk-adjusted hospital mortality. Risk-adjusted hospital length of stay (HLOS) was also studied. The SMR for the overall ICU population was 0.83 pre-TCC and 0.75 post-TCC, with risk-adjusted mortalities of 10.7% and 9.5% (p = 0.09). In the identified lower-performing patient group, which accounted for 12.6% (n = 307) of pre-TCC and 13.3% (n = 1671) of post-TCC ICU patients, SMR decreased from 1.61 (95% CI, 1.21-2.01) pre-TCC to 1.03 (95% CI, 0.91-1.15) post-TCC, and risk-adjusted mortality decreased from 26.4% to 16.9% (p < 0.001). In the remaining ("higher-performing") patient group, there was no change in pre- versus post-TCC SMR (0.70 [0.59-0.81] vs 0.69 [0.64-0.73]) or risk-adjusted mortality (8.5% vs 8.4%, p = 0.86). There were no pre- to post-TCC differences in standardized HLOS ratio or risk-adjusted HLOS in the overall cohort or either performance group. CONCLUSIONS In well-staffed and overall higher-performing ICUs in an academic medical center, Acute Physiology and Chronic Health Evaluation granularity allowed identification of a historically lower-performing patient group that experienced a striking TCC-associated reduction in SMR and risk-adjusted mortality. This study provides additional evidence for the relationship between pre-TCC performance and post-TCC improvement.
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Affiliation(s)
- Walter A Boyle
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Christopher M Palmer
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | | | - Bradley A Fritz
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Ayesha Iqbal
- Center for Clinical Excellence, BJC Healthcare, St. Louis, MO
| | | | | | - Paul Kerby
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Sara Buckman
- Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Vladimir Despotovic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Jim Kozlowski
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | | | - Igor Zwir
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
- Department of Computer Science and Artificial Intelligence, University of Granada, Granada, Spain
| | - C Charles Gu
- Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Uchenna R Ofoma
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
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Armaignac DL, Ramamoorthy V, DuBouchet EM, Williams LM, Kushch NA, Gidel L, Badawi O. Descriptive Comparison of Two Models of Tele-Critical Care Delivery in a Large Multi-Hospital Health Care System. Telemed J E Health 2023; 29:1465-1475. [PMID: 36827094 DOI: 10.1089/tmj.2022.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Introduction: The Society of Critical Care Medicine Tele-Critical Care (TCC) Committee has identified the need for rigorous comparative research of different TCC delivery models to support the development of best practices for staffing, application, and approaches to workflow. Our objective was to describe and compare outcomes between two TCC delivery models, TCC with 24/7 Bedside Intensivist (BI) compared with TCC with Private Daytime Attending Intensivist (PI) in relation to intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), cost, and complications across the spectrum of routine ICU standards of care. Methods: Observational cohort study at large health care system in 12 ICUs and included patients, ≥18, with Acute Physiology and Chronic Health Evaluation (APACHE) IVa scores and predictions (October 2016-June 2019). Results: Of the 19,519 ICU patients, 71.7% (n = 13,993) received TCC with 24/7 BI while 28.3% (n = 5,526) received TCC with PI. ICU and Hospital mortality (4.8% vs. 3.1%, p < 0.0001; 12.6% vs. 8.1%, p < 0.001); and ICU and Hospital LOS (3.2 vs. 2.4 days, p < 0.001; 9.8 vs. 7.2 days, p < 0.001) were significantly higher among 24/7 BI compared with PI. The APACHE observed/expected ratios (odds ratio [OR]; 95% confidence interval [CI]) for ICU mortality (0.62; 0.58-0.67) vs. (0.53; 0.46-0.61) and Hospital mortality (0.95; 0.57-1.48) vs. (0.77; 0.70-0.84) were significantly different for 24/7 BI compared with PI. Multivariate mixed models that adjusted for confounders demonstrated significantly greater odds of (OR; 95% CI) ICU mortality (1.58; 1.28-1.93), Hospital mortality (1.52; 1.33-1.73), complications (1.55; 1.18-2.04), ICU LOS [3.14 vs. 2.59 (1.25; 1.19-1.51)], and Hospital LOS [9.05 vs. 7.31 (1.23; 1.21-1.25)] among 24/7 BI when compared with PI. Sensitivity analyses adjusting for ICU admission within 24 h of hospital admission, receiving active ICU treatments, nighttime admission, sepsis, and highest third acute physiology score indicated significantly higher odds for 24/7 BI compared with PI. Conclusion: Our comparison demonstrated that TCC delivery model with PI provided high-quality care with significant positive effects on outcomes. This suggests that TCC delivery models have broad-ranging applicability and benefits in routine critical care, thus necessitating progressive research in this direction.
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Affiliation(s)
- Donna Lee Armaignac
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | | | - Eduardo Martinez DuBouchet
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | - Lisa-Mae Williams
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
- Wertheim School of Medicine, Florida International University, Miami, Florida, USA
| | | | - Louis Gidel
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
- Tele-Critical Care, Telehealth Center, Baptist Health South Florida, Miami, Florida, USA
| | - Omar Badawi
- School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
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Dhala A, Fusaro MV, Uddin F, Tuazon D, Klahn S, Schwartz R, Sasangohar F, Alegria J, Masud F. Integrating a Virtual ICU with Cardiac and Cardiovascular ICUs: Managing the Needs of a Complex and High-Acuity Specialty ICU Cohort. Methodist Debakey Cardiovasc J 2023; 19:4-16. [PMID: 37547898 PMCID: PMC10402825 DOI: 10.14797/mdcvj.1247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 08/08/2023] Open
Abstract
A long-standing shortage of critical care intensivists and nurses, exacerbated by the coronavirus disease (COVID-19) pandemic, has led to an accelerated adoption of tele-critical care in the United States (US). Due to their complex and high-acuity nature, cardiac, cardiovascular, and cardiothoracic intensive care units (ICUs) have generally been limited in their ability to leverage tele-critical care resources. In early 2020, Houston Methodist Hospital (HMH) launched its tele-critical care program called Virtual ICU, or vICU, to improve its ICU staffing efficiency while providing high-quality, continuous access to in-person and virtual intensivists and critical care nurses. This article provides a roadmap with prescriptive specifications for planning, launching, and integrating vICU services within cardiac and cardiovascular ICUs-one of the first such integrations among the leading academic US hospitals. The success of integrating vICU depends upon the (1) recruitment of intensivists and RNs with expertise in managing cardiac and cardiovascular patients on the vICU staff as well as concerted efforts to promote mutual trust and confidence between in-person and virtual providers, (2) consultations with the bedside clinicians to secure their buy-in on the merits of vICU resources, and (3) collaborative approaches to improve workflow protocols and communications. Integration of vICU has resulted in the reduction of monthly night-call requirements for the in-person intensivists and an increase in work satisfaction. Data also show that support of the vICU is associated with a significant reduction in the rate of Code Blue events (denoting a situation where a patient requires immediate resuscitation, typically due to a cardiac or respiratory arrest). As the providers become more comfortable with the advances in artificial intelligence and big data-driven technology, the Cardiac ICU Cohort continues to improve methods to predict and track patient trends in the ICUs.
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Affiliation(s)
- Atiya Dhala
- Houston Methodist Hospital, Houston, Texas, US
| | | | - Faisal Uddin
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Divina Tuazon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Steven Klahn
- Department of Virtual Medicine, Houston Methodist Hospital, Houston, Texas, US
| | | | - Farzan Sasangohar
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas, US
- Texas A&M University, College Station, Texas, US
| | | | - Faisal Masud
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Murray NM, Marshall S, Hoesch R, Hobbs K, Smith S, Roller D, Thomas K, Meier K, Puttgen A. Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy. Neurocrit Care 2023; 38:650-656. [PMID: 36324004 DOI: 10.1007/s12028-022-01632-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/07/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teleneurocritical care (TNCC) provides 24/7 virtual treatment of patients with neurological disease in the emergency department or intensive care unit. However, it is not known if TNCC is safe, effective, or associated with similar outcomes compared with in-person neurocritical care. We aim to determine the effect of daily inpatient consults from TNCC on the outcomes of patients with large vessel occlusive acute ischemic stroke treated by thrombectomy. METHODS A multicenter, retrospective cohort of consecutive patients ≥ 18 years old with acute ischemic stroke from a large vessel occlusion treated by thrombectomy were identified from 2018 to 2021 within a telehealth network of an integrated not-for-profit health care system in the United States. The primary end point was good functional outcome, i.e., modified Rankin Scale 0-3, at the time of hospital discharge in patients receiving in-person neurocritical care versus TNCC. RESULTS A total of 437 patients met inclusion criteria, 226 at the in-person hospital (median age 67, 53% women) and 211 at the two TNCC hospitals (median age 74, 49% women). The rate of successful endovascular therapy (modified Thrombolysis in Cerebral Infarction score 2b-3) was not different among hospitals. Good functional outcome at discharge was similar between in-person neurocritical care and TNCC (in-person 31.4% vs. TNCC 33.5%, odds ratio 0.88, 95% confidence interval 0.6-1.3; p = 0.64). Only National Institutes of Health stroke scale and age were multivariable predictors of outcome. There were no differences in mortality (9.3% vs. 13.2%, p = 0.19), intensive care unit length of stay (2.1 vs. 1.9 days, p = 0.39), or rate of symptomatic intracerebral hemorrhage (6.8% vs. 6.6%, p = 0.47) between in-person neurocritical care and TNCC. CONCLUSIONS Teleneurocritical care allows for equivalent favorable functional outcomes compared with in-person neurocritical care for patients with acute large vessel ischemic stroke receiving thrombectomy. The standardized protocols used by TNCC in this study, specifically the comprehensive 24/7 treatment of patients in the intensive care unit for the length of their stay, may be relevant for other health systems with limited in-person resources; however, additional study is required.
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Affiliation(s)
- Nick M Murray
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA.
| | - Scott Marshall
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Robert Hoesch
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Kyle Hobbs
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Shawn Smith
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Dean Roller
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Katherine Thomas
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Kevin Meier
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Adrian Puttgen
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
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Xyrichis A, Iliopoulou K. Telehealth in the intensive care unit: Current insights and future directions. Intensive Crit Care Nurs 2023:103412. [PMID: 36813610 DOI: 10.1016/j.iccn.2023.103412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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von Schumann S, Ullrich C, Weis A, Wensing M, Litke N. Interprofessional weaning boards for invasively ventilated patients in intensive care units: Qualitative interview study with healthcare professionals in Germany. Res Nurs Health 2023; 46:148-158. [PMID: 36453115 DOI: 10.1002/nur.22279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 12/05/2022]
Abstract
Numbers of mechanically ventilated patients are increasing worldwide. Weaning Boards could support weaning from the ventilator by facilitating interprofessional consultations between Weaning Centers and nonpneumological intensive care units. This study, which is linked to the project Prevention of invasive Ventilation, aimed to explore the design and implementation of future Weaning Boards. Semistructured interviews were conducted with physicians, nurses, respiratory therapists, and physiotherapists of intensive care units and Weaning Centers in Baden-Wuerttemberg, Germany. Participants were asked to share their views on (a) required characteristics of Weaning Boards and (b) the current care of weaning patients in their wards. Qualitative data analysis included inductive and deductive steps referring to the Template for Intervention Description and Replication checklist and the Consolidated Framework for Implementation Research. The 14 interviewed healthcare professionals addressed characteristics of future Weaning Boards including (a) preconditions, (b) procedure, (c) interprofessional participants, (d) type of performance, and (d) time frame. Identified determinants for successful implementation were related to (a) individual characteristics of healthcare professionals, (b) ward characteristics, and (c) healthcare system characteristics. Weaning Boards could be a useful tool to advance knowledge sharing between professionals, improve education about weaning protocols, and support patient-oriented care. The implementation of Weaning Boards can be influenced by individual characteristics of participating professionals, difficulties in the interaction between professional groups, the present workplace culture, and the current coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Selina von Schumann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Litke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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12
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Kwizera A, Sendagire C, Kamuntu Y, Rutayisire M, Nakibuuka J, Muwanguzi PA, Alenyo-Ngabirano A, Kyobe-Bosa H, Olaro C. Building Critical Care Capacity in a Low-Income Country. Crit Care Clin 2022; 38:747-759. [PMID: 36162908 PMCID: PMC9507099 DOI: 10.1016/j.ccc.2022.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Critical illness is common throughout the world and is associated with high costs of care and resource intensity. The Corona virus disease 2019 (COVID-19) pandemic created a sudden surge of critically ill patients, which in turn led to devastating effects on health care systems worldwide and more so in Africa. This narrative report describes how an attempt was made at bridging the existing gaps in quality of care for critically ill patients at national and regional levels for COVID and the postpandemic era in a low income country.
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Affiliation(s)
- Arthur Kwizera
- Department of Anaesthesia and Critical Care, Makerere University, College of Health Sciences, Plot 1 Upper Mulago Hill Road, P O Box 2191, Kampala, Uganda,Corresponding author
| | - Cornelius Sendagire
- Department of Anaesthesia and Critical Care, Makerere University, College of Health Sciences, Plot 1 Upper Mulago Hill Road, P O Box 2191, Kampala, Uganda
| | - Yewande Kamuntu
- Clinton Health Access Initiative, Plot 8a, Moyo Close, P O Box 2191, Kampala, Uganda
| | - Meddy Rutayisire
- Department of Anaesthesia and Critical Care, Makerere University, College of Health Sciences, Plot 1 Upper Mulago Hill Road, P O Box 2191, Kampala, Uganda
| | - Jane Nakibuuka
- Department of Medicine, Intensive Care Unit, Mulago National Referral Hospital, Plot 1 Upper Mulago Hill Road, P O Box 2191, Kampala, Uganda
| | - Patience A. Muwanguzi
- Department of Nursing, College of Health Sciences, Makerere University, Plot 1 Upper Mulago Hill Road, P O Box 2191, Kampala, Uganda
| | | | - Henry Kyobe-Bosa
- Ministry of Health, Plot 6 Lourdel Road, P O Box 2191, Wandegeya, Kampala, Uganda,Uganda Peoples Defense Forces, Chwa II Road, Mbuya , P O Box 2191, Kampala, Uganda,Kellogg College, University of Oxford, 60-62 Banbury Road, Park Town, Oxford OX2 6PN, United Kingdom
| | - Charles Olaro
- Ministry of Health, Plot 6 Lourdel Road, P O Box 2191, Wandegeya, Kampala, Uganda
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13
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Telemedicine to Expand Access to Critical Care Around the World. Crit Care Clin 2022; 38:809-826. [PMID: 36162912 DOI: 10.1016/j.ccc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This multiauthored communication gives a state-of-the-art global perspective on the increasing adoption of tele-critical care. Exponentially increasing sophistication in the deployment of Computers, Information, and Communication Technology has ensured extending the reach of limited intensivists virtually and reaching the unreached. Natural disasters, COVID-19 pandemic, and wars have made tele-intensive care a reality. Concerns and regulatory issues are being sorted out, cross-border cost-effective tele-critical care is steadily increasing Components to set up a tele-intensive care unit, and overcoming barriers is discussed. Importance of developing best practice guidelines and retraining is emphasized.
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14
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Laukka E, Pölkki T, Kanste O. Leadership in the Context of Digital Health Services: A Concept Analysis. J Nurs Manag 2022; 30:2763-2780. [PMID: 35942802 PMCID: PMC10087820 DOI: 10.1111/jonm.13763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/06/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
AIM To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model. BACKGROUND Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. METHOD Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO), and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents, or consequences of leadership in the study context. A total of 4,037 references were identified; 23 were included. RESULTS Leadership attributes concerned leaders' behavior, roles, and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity, and education. Consequences related to organization, professionals, and patient and care. CONCLUSION Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research. IMPLICATIONS FOR NURSING MANAGEMENT Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth, and benefit clinicians and patients.
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Affiliation(s)
- Elina Laukka
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
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15
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Laudanski K, Huffenberger AM, Scott MJ, Williams M, Wain J, Jablonski J, Hanson CW. Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers. Front Med (Lausanne) 2022; 9:883126. [PMID: 35991667 PMCID: PMC9388902 DOI: 10.3389/fmed.2022.883126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Our study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during interactions with the bedside team have not been characterized systematically. These characteristics are critical for planning the deployment of teleICU services and preventing burnout among remote teleICU providers. Methods REDCap self-reported activity logs collected engagement duration, triggers (emergency button, tele-CCM software platform, autonomous algorithm, asymmetrical communication platform, phone), expediency, nature (proactive rounding, predetermined task, response to medical needs), communication modes, and acceptance. Seven hospitals with 16 ICUs were overseen between 9/2020 and 9/2021 by teams consisting of telemedicine medical doctors (eMD), telemedicine registered nurses (eRN), and telemedicine respiratory therapists (eRT). Results 39,915 total engagements were registered. eMDs had a significantly higher percentage of emergent and urgent engagements (31.9%) vs. eRN (9.8%) or eRT (1.7%). The average tele-CCM intervention took 16.1 ± 10.39 min for eMD, 18.1 ± 16.23 for eRN, and 8.2 ± 4.98 min for eRT, significantly varied between engagement, and expediency, hospitals, and ICUs types. During the observation period, there was a shift in intervention triggers with an increase in autonomous algorithmic ARDS detection concomitant with predominant utilization of asynchronous communication, phone engagements, and the tele-CCM module of electronic medical records at the expense of the share of proactive rounding. eRT communicated more frequently with bedside staff (% MD = 37.8%; % RN = 36.8, % RT = 49.0%) but mostly with other eRTs. In contrast, the eMD communicated with all ICU stakeholders while the eRN communicated chiefly with other RN and house staff at the patient's bedside. The rate of distress reported by tele-CCM staff was 2% among all interactions, with the entity hospital being the dominant factor. Conclusions Delivery of tele-CCM services has to be tailored to the specific beneficiary of tele-CCM services to optimize care delivery and minimize distress. In addition, the duration of the average intervention must be considered while creating an efficient workflow.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute for Healthcare Economics, Philadelphia, PA, United States
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Krzysztof Laudanski
| | - Ann Marie Huffenberger
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Michael J. Scott
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Maria Williams
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Justin Wain
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
| | - Juliane Jablonski
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | - C. William Hanson
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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16
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Laudanski K, Huffenberger AM, Scott MJ, Wain J, Ghani D, Hanson CW. Pilot of rapid implementation of the advanced practice provider in the workflow of an existing tele-critical care program. BMC Health Serv Res 2022; 22:855. [PMID: 35780144 PMCID: PMC9250728 DOI: 10.1186/s12913-022-08251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Incorporating the advanced practice provider (APP) in the delivery of tele critical care medicine (teleCCM) addresses the critical care provider shortage. However, the current literature lacks details of potential workflows, deployment difficulties and implementation outcomes while suggesting that expanding teleCCM service may be difficult. Here, we demonstrate the implementation of a telemedicine APP (eAPP) pilot service within an existing teleCCM program with the objective of determining the feasibility and ease of deployment. The goal is to augment an existing tele-ICU system with a balanced APP service to assess the feasibility and potential impact on the ICU performance in several hospitals affiliated within a large academic center. A REDCap survey was used to assess eAPP workflows, expediency of interventions, duration of tasks, and types of assignments within different service locations. Between 02/01/2021 and 08/31/2021, 204 interventions (across 133 12-h shift) were recorded by eAPP (nroutine = 109 (53.4%); nurgent = 82 (40.2%); nemergent = 13 (6.4%). The average task duration was 10.9 ± 6.22 min, but there was a significant difference based on the expediency of the task (F [2; 202] = 3.89; p < 0.022) and type of tasks (F [7; 220] = 6.69; p < 0.001). Furthermore, the eAPP task type and expediency varied depending upon the unit engaged and timeframe since implementation. The eAPP interventions were effectively communicated with bedside staff with only 0.5% of suggestions rejected. Only in 2% cases did the eAPP report distress. In summary, the eAPP can be rapidly deployed in existing teleCCM settings, providing adaptable and valuable care that addresses the specific needs of different ICUs while simultaneously enhancing the delivery of ICU care. Further studies are needed to quantify the input more robustly.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute for Health Economics, Philadelphia, PA, 19104, USA. .,Department of Anesthesiology and Critical Care, Leonard Davis Institute for Health Economic, JMB 127; 3620 Hamilton Walk, Philadelphia, PA, 19146, USA.
| | | | - Michael J Scott
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Justin Wain
- School of Osteopathic Medicine, Campbell University, Buies Creek, NC, 27506, USA.,Penn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danyal Ghani
- College of Art & Sciences, Drexel University, Philadelphia, PA, 19104, USA
| | - C William Hanson
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
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17
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Ofoma UR, Drewry AM, Maddox TM, Boyle W, Deych E, Kollef M, Girotra S, Joynt Maddox KE. Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care. Resuscitation 2022; 177:7-15. [PMID: 35724851 PMCID: PMC9296566 DOI: 10.1016/j.resuscitation.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours. OBJECTIVE To evaluate the association between hospital availability of TCC and IHCA survival. METHODS We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday-Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays). RESULTS 14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction). CONCLUSIONS Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.
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Affiliation(s)
- Uchenna R Ofoma
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA.
| | - Anne M Drewry
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Thomas M Maddox
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA; Healthcare Innovation Laboratory, BJC Healthcare and Washington University School of Medicine, St. Louis, MO, USA
| | - Walter Boyle
- Division of Critical Care Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Elena Deych
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Saket Girotra
- Division of Cardiovascular Diseases, Department of Medicine, University of Iowa Hospitals and Clinics and the Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Karen E Joynt Maddox
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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18
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Murray NM, Hobbs K, Smith S, Püttgen A. Teleneurocritical Care: Lessons Learned in Standardizing Care. Neurocrit Care 2022; 36:691-694. [PMID: 35359222 DOI: 10.1007/s12028-022-01478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nick M Murray
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA.
| | - Kyle Hobbs
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Shawn Smith
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
| | - Adrian Püttgen
- Department of Neurology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA
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19
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Udeh C, Perez-Protto S, Canfield CM, Sreedharan R, Factora F, Hata JS. Outcomes Associated with ICU Telemedicine and Other Risk Factors in a Multi-Hospital Critical Care System: A Retrospective, Cohort Study for 30-Day In-Hospital Mortality. Telemed J E Health 2022; 28:1395-1403. [PMID: 35294855 DOI: 10.1089/tmj.2021.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Intensive care unit telemedicine (ICU-TM) is expanding due to increasing demands for critical care, but impact on outcomes remains controversial. This study evaluated the association of ICU-TM and other clinical factors with 30-day, in-hospital mortality. Methods: This retrospective, cohort study included 151,780 consecutive ICU patients admitted to nine hospitals in the Cleveland Clinic Health System from 2010 to 2020. Patients were identified from an institutional datamart and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) registry. Primary outcome was 30-day in-hospital mortality. Analyses included multivariate logistic regression modeling, and survival analysis. Results: Overall, unadjusted 30-day, in-hospital mortality incidence was significantly different with (5.6%) or without ICU-TM (7.2%), and risk ratio was 0.78 (95% confidence interval [CI] 0.75-0.81) (p < 0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.4/1,000 versus 3.2/1,000 patient days, respectively (p < 0.0001). Multivariate logistic regression showed that ICU-TM was associated with reduced 30-day mortality (odds ratio 0.78, 95% CI 0.72-0.83). Increased risk was seen with cardiac arrest admissions, males, acute stroke, weekend admission, emergency admission, race (non-white), sepsis, APACHE IV score, ICU length of stay (LOS), and the interaction term, emergency surgical admissions. Reduced risk was associated with hospital LOS, surgical admission, and the interaction terms (weekend admissions with ICU-TM and after-hour admissions with ICU-TM). The model c-statistic was 0.77. Median ICU and hospital lengths of stay were significantly reduced with ICU-TM, with no difference in 48-h mortality or 48-h mortality rate. Conclusion: ICU telemedicine exposure appears to be one of several operational and clinical factors associated with reduced 30-day, in-hospital mortality.
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Affiliation(s)
- Chiedozie Udeh
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Silvia Perez-Protto
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Christina M Canfield
- Cleveland Clinic Foundation, Division of Medical Operations, Cleveland, Ohio, USA
| | - Roshni Sreedharan
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Faith Factora
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - J Steven Hata
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
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20
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Michael Robie E, Cole S, Suwal A, Coustasse A. Tele-ICU in the Unites States: Is a cost-effective model? INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. Michael Robie
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Stephanie Cole
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Archana Suwal
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
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21
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Guinemer C, Boeker M, Fürstenau D, Poncette AS, Weiss B, Mörgeli R, Balzer F. Telemedicine in Intensive Care Units: Scoping Review. J Med Internet Res 2021; 23:e32264. [PMID: 34730547 PMCID: PMC8600441 DOI: 10.2196/32264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 09/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The role of telemedicine in intensive care has been increasing steadily. Tele-intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. OBJECTIVE This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. METHODS A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. RESULTS A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. CONCLUSIONS The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19695.
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Affiliation(s)
- Camille Guinemer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Boeker
- Intelligence and Informatics in Medicine, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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22
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Bentellis I, Guérin S, Khene ZE, Khavari R, Peyronnet B. Artificial intelligence in functional urology: how it may shape the future. Curr Opin Urol 2021; 31:385-390. [PMID: 33989231 DOI: 10.1097/mou.0000000000000888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The aim of the present manuscript is to provide an overview on the current state of artificial intelligence (AI) tools in either decision making, diagnosis, treatment options, or outcome prediction in functional urology. RECENT FINDINGS Several recent studies have shed light on the promising potential of AI in functional urology to investigate lower urinary tract dysfunction pathophysiology but also as a diagnostic tool by enhancing the existing evaluations such as dynamic magnetic resonance imaging or urodynamics. AI may also improve surgical education and training because of its automated performance metrics recording. By bringing prediction models, AI may also have strong therapeutic implications in the field of functional urology in the near future. AI may also be implemented in innovative devices such as e-bladder diary and electromechanical artificial urinary sphincter and could facilitate the development of remote medicine. SUMMARY Over the past decade, the enthusiasm for AI has been rising exponentially. Machine learning was well known, but the increasing power of processors and the amount of data available has provided the platform for deep learning tools to expand. Although the literature on the applications of AI technology in the field of functional urology is relatively sparse, its possible uses are countless especially in surgical training, imaging, urodynamics, and innovative devices.
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Affiliation(s)
- Imad Bentellis
- Department of Urology, University of Nice-Sophia Antipolis, Nice
| | | | | | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
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Regionalization of Critical Care in the United States: Current State and Proposed Framework From the Academic Leaders in Critical Care Medicine Task Force of the Society of the Critical Care Medicine. Crit Care Med 2021; 50:37-49. [PMID: 34259453 DOI: 10.1097/ccm.0000000000005147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions. DATA SOURCES AND STUDY SELECTION Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product. DATA EXTRACTION AND SYNTHESIS The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations. CONCLUSIONS Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.
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The Era of Evidence-Based ICU Telemedicine. Crit Care Med 2021; 49:1217-1218. [PMID: 34135283 DOI: 10.1097/ccm.0000000000004996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aborujilah A, Elsebaie AEFM, Mokhtar SA. IoT MEMS: IoT-Based Paradigm for Medical Equipment Management Systems of ICUs in Light of COVID-19 Outbreak. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:131120-131133. [PMID: 34786319 PMCID: PMC8545208 DOI: 10.1109/access.2021.3069255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 06/13/2023]
Abstract
Recently, COVID-19 has infected a lot of people around the world. The healthcare systems are overwhelmed because of this virus. The intensive care unit (ICU) as a part of the healthcare sector has faced several challenges due to the poor information quality provided by current ICUs' medical equipment management. IoT has raised the ability for vital data transfer in the healthcare sector of the new century. However, most of the existing paradigms have adopted IoT technology to track patients' health statuses. Therefore, there is a lack of understanding on how to utilize such technology for ICUs' medical equipment management. This paper proposes a novel IoT-based paradigm called IoT Based Paradigm for Medical Equipment Management Systems (IoT MEMS) to manage medical equipment of ICUs efficiently. It employs IoT technology to enhance the information flow between medical equipment management systems (THIS) and ICUs during the COVID-19 outbreak to ensure the highest level of transparency and fairness in reallocating medical equipment. We described in detail the theoretical and practical aspects of IoT MEMS. Adopting IoT MEMS will enhance hospital capacity and capability in mitigating COVID-19 efficiently. It will also positively influence the information quality of (THIS) and strengthen trust and transparency among the stakeholders.
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Affiliation(s)
- Abdulaziz Aborujilah
- Malaysian Institute of Information Technology (MIIT), University of Kuala LumpurKuala Lumpur50250Malaysia
| | | | - Shamsul Anuar Mokhtar
- Malaysian Institute of Information Technology (MIIT), University of Kuala LumpurKuala Lumpur50250Malaysia
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Krupp A, Di Martino M, Chung W, Chaiyachati K, Agarwal AK, Huffenberger AM, Laudanski K. Communication and role clarity inform TeleICU use: a qualitative analysis of opportunities and barriers in an established program using AACN framework. BMC Health Serv Res 2021; 21:277. [PMID: 33766010 PMCID: PMC7992609 DOI: 10.1186/s12913-021-06287-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/17/2021] [Indexed: 01/24/2023] Open
Abstract
Background Understanding the use of tele-intensive care unit (ICU) services is an essential component in evaluating current practice and informing future use as the adoption and application of teleICU services expands. We sought to explore if novel ways to utilize teleICU services can emerge within an established, consulting-style teleICU model considering the program’s flexible, provider-driven operation. Methods This was a qualitative study of one teleICU/hospital dyad using semi-structured interviews from a convenience sample of ICU (n = 19) and teleICU (n = 13) nurses. Interviews were analyzed using directed content analysis to identify themes that describe their experiences with teleICU using a deductive codebook developed from an expert consensus (American Association of Critical Care Nurses) AACN statement on teleICU nursing. Results Three themes were identified through the qualitative content analysis: [1] nurses described unique teleICU knowledge, including systems thinking and technological skills, [2] the teleICU partnership supported quality improvement initiatives, and [3] elements of the work environment influenced perceptions of teleICU and its use. When elements of the work environment, such as effective communication and role clarity, were not present, teleICU use was variable. Conclusions Flexible, provider-driven approaches for integrating teleICU services into daily practice may help define the future use of the teleICU model’s applicability. Future work should focus on the importance of effective communication and role clarity in integrating the emerging teleICU services into teleICU/ICU practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06287-6.
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Affiliation(s)
- Anna Krupp
- College of Nursing, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael Di Martino
- College of Arts and Sciences, University of Pennsylvania, 249 South 36th St, Philadelphia, PA, 19104, USA
| | - Wesley Chung
- Department of Chemistry, College of Arts and Sciences, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
| | - Krisda Chaiyachati
- The Department of Medicine, The University of Pennsylvania Perelman School of Medicine, The Leonard Davis Institute for Health Economics at the University of Pennsylvania, Penn Medicine Center for Connected Care, Philadelphia, PA, 19104, USA
| | - Anish K Agarwal
- The Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Leonard Davis Institute for Health Economics at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ann Marie Huffenberger
- Penn Medicine Center for Connected Care, The Clinical Practices of the University of Pennsylvania Health System, Philadelphia, PA, 19104, USA
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care; University of Pennsylvania, JMB 127, 3620 Hamilton Walk, Philadelphia, PA, 19146, USA. .,Leonard Davis Institute for Healthcare Economics , JMB 127, 3620 Hamilton Walk, Philadelphia, PA, 19146, USA.
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Kerlin MP, Costa DK, Kahn JM. The Society of Critical Care Medicine at 50 Years: ICU Organization and Management. Crit Care Med 2021; 49:391-405. [PMID: 33555776 DOI: 10.1097/ccm.0000000000004830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Meeta Prasad Kerlin
- Division of Pulmonary, Allergy, and Critical Care Medicine and Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Deena Kelly Costa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Institute for Healthcare Innovation & Policy, University of Michigan, Ann Arbor, MI
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Preliminary Development of Value Scorecards as ICU Telemedicine Evaluation Tools. J Healthc Manag 2021; 66:124-138. [PMID: 33692317 DOI: 10.1097/jhm-d-19-00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Intensive care unit (ICU) telemedicine has grown exponentially to the point that approximately 10% of U.S. hospitals use such programs. However, no studies have focused on strategic decision tools in the context of rural hospitals. We applied the pervasive balanced scorecard framework and used a sequential, mixed methods design with qualitative and quantitative data sources. We then triangulated them to generate value scorecards for four rural South Carolina hospitals. Four domains, each with numerous components, were identified and compiled to create a composite value scorecard. Domains and numbers of components included organizational (n = 10), clinical (n = 5), financial (n = 8), and strategic (n = 3) effects of ICU telemedicine. When weighting each component within domains and then comparing across hospitals, we identified substantial variation in the relative value derived from ICU telemedicine. Our novel, multidimensional value scorecard could be prospectively applied by hospitals seeking a structured approach to decision-making for ICU telemedicine investments.
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Xyrichis A, Iliopoulou K, Mackintosh NJ, Bench S, Terblanche M, Philippou J, Sandall J. Healthcare stakeholders' perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 2:CD012876. [PMID: 33599282 PMCID: PMC8097132 DOI: 10.1002/14651858.cd012876.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Critical care telemedicine (CCT) has long been advocated for enabling access to scarce critical care expertise in geographically-distant areas. Additional advantages of CCT include the potential for reduced variability in treatment and care through clinical decision support enabled by the analysis of large data sets and the use of predictive tools. Evidence points to health systems investing in telemedicine appearing better prepared to respond to sudden increases in demand, such as during pandemics. However, challenges with how new technologies such as CCT are implemented still remain, and must be carefully considered. OBJECTIVES This synthesis links to and complements another Cochrane Review assessing the effects of interactive telemedicine in healthcare, by examining the implementation of telemedicine specifically in critical care. Our aim was to identify, appraise and synthesise qualitative research evidence on healthcare stakeholders' perceptions and experiences of factors affecting the implementation of CCT, and to identify factors that are more likely to ensure successful implementation of CCT for subsequent consideration and assessment in telemedicine effectiveness reviews. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and Web of Science for eligible studies from inception to 14 October 2019; alongside 'grey' and other literature searches. There were no language, date or geographic restrictions. SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis. Studies included views from healthcare stakeholders including bedside and CCT hub critical care personnel, as well as administrative, technical, information technology, and managerial staff, and family members. DATA COLLECTION AND ANALYSIS We extracted data using a predetermined extraction sheet. We used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess the methodological rigour of individual studies. We followed the Best-fit framework approach using the Consolidated Framework for Implementation Research (CFIR) to inform our data synthesis. We classified additional themes not captured by CFIR under a separate theme. We used the GRADE CERQual approach to assess confidence in the findings. MAIN RESULTS We found 13 relevant studies. Twelve were from the USA and one was from Canada. Where we judged the North American focus of the studies to be a concern for a finding's relevance, we have reflected this in our assessment of confidence in the finding. The studies explored the views and experiences of bedside and hub critical care personnel; administrative, technical, information technology, and managerial staff; and family members. The intensive care units (ICUs) were from tertiary hospitals in urban and rural areas. We identified several factors that could influence the implementation of CCT. We had high confidence in the following findings: Hospital staff and family members described several advantages of CCT. Bedside and hub staff strongly believed that the main advantage of CCT was having access to experts when bedside physicians were not available. Families also valued having access to critical care experts. In addition, hospital staff described how CCT could support clinical decision-making and mentoring of junior staff. Hospital staff greatly valued the nature and quality of social networks between the bedside and CCT hub teams. Key issues for them were trust, acceptance, teamness, familiarity and effective communication between the two teams. Interactions between some bedside and CCT hub staff were featured with tension, frustration and conflict. Staff on both sides commonly described disrespect of their expertise, resistance and animosity. Hospital staff thought it was important to promote and offer training in the use of CCT before its implementation. This included rehearsing every step in the process, offering staff opportunities to ask questions and disseminating learning resources. Some also complained that experienced staff were taken away from bedside care and re-allocated to the CCT hub team. Hospital staff's attitudes towards, knowledge about and value placed on CCT influenced acceptance of CCT. Staff were positive towards CCT because of its several advantages. But some were concerned that the CCT hub staff were not able to understand the patient's situation through the camera. Some were also concerned about confidentiality of patient data. We also identified other factors that could influence the implementation of CCT, although our confidence in these findings is moderate or low. These factors included the extent to which telemedicine software was adaptable to local needs, and hub staff were aware of local norms; concerns about additional administrative work and cost; patients' and families' desire to stay close to their local community; the type of hospital setting; the extent to which there was support from senior leadership; staff access to information about policies and procedures; individuals' stage of change; staff motivation, competence and values; clear strategies for staff engagement; feedback about progress; and the impact of CCT on staffing levels. AUTHORS' CONCLUSIONS Our review identified several factors that could influence the acceptance and use of telemedicine in critical care. These include the value that hospital staff and family members place on having access to critical care experts, staff access to sufficient training, and the extent to which healthcare providers at the bedside and the critical care experts supporting them from a distance acknowledge and respect each other's expertise. Further research, especially in contexts other than North America, with different cultures, norms and practices will strengthen the evidence base for the implementation of CCT internationally and our confidence in these findings. Implementation of CCT appears to be growing in importance in the context of global pandemic management, especially in countries with wide geographical dispersion and limited access to critical care expertise. For successful implementation, policymakers and other stakeholders should consider pre-empting and addressing factors that may affect implementation, including strengthening teamness between bedside and hub teams; engaging and supporting frontline staff; training ICU clinicians on the use of CCT prior to its implementation; and ensuring staff have access to information and knowledge about when, why and how to use CCT for maximum benefit.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katerina Iliopoulou
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Nicola J Mackintosh
- SAPPHIRE, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Suzanne Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - Marius Terblanche
- Critical Care Medicine/ Division of Health and Social Care Research, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Udeh C, Briskin I, Canfield C. Association of Unit-Level Telecritical Care Intensity of Service and Length of Stay in the Intensive Care Unit. Telemed J E Health 2021; 27:1123-1128. [PMID: 33471601 DOI: 10.1089/tmj.2020.0453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telecritical care (TCC) has been shown to improve outcomes in the intensive care unit (ICU). A TCC was developed and implemented a nocturnal TCC across 10 ICUs in our Health System. TCC coverage patterns and level of involvement vary among ICUs. We identified an opportunity to determine the impact of TCC involvement on the ICU length of stay (LOS). Objective: The primary objective of this study was to assess if intensity of service provided by TCC impacts ICU LOS. Methods: This retrospective review was conducted for all patients admitted to covered ICUs during a 2-year period. ICUs were stratified by the coverage model provided by the TCC and the count of orders placed by the TCC served as a surrogate for intensity of service. Confounding variables were abstracted from the Acute Physiology and Chronic Health Evaluation (APACHE) databases. Spearman's rank correlation coefficient was used to measure the strength of the relationship between ICU LOS and TCC order volume. A linear regression model was used to describe the relationship between order volume and ICU LOS, while adjusting for confounding variables. Results: There is a strong negative relationship between TCC order volume and ICU LOS, as shown by the Spearman rank correlation coefficient of -0.818. The associated p-value of 0.0038 supports the strength of this relationship. Conclusion: Our results demonstrate the impact of nocturnal TCC involvement in patient care. As TCC order volume per ICU admission increases, ICU LOS decreases. We interpret this as an indication for deeper involvement between the TCC team and any on-site providers.
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Affiliation(s)
- Chiedozie Udeh
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Isaac Briskin
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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31
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Guinemer C, Boeker M, Weiss B, Fuerstenau D, Balzer F, Poncette AS. Telemedicine in Intensive Care Units: Protocol for a Scoping Review. JMIR Res Protoc 2020; 9:e19695. [PMID: 33382040 PMCID: PMC7808887 DOI: 10.2196/19695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/31/2020] [Accepted: 11/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background Telemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account. Objective We present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case. Methods We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021. Results The preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts. Conclusions The results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified. International Registered Report Identifier (IRRID) DERR1-10.2196/19695
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Affiliation(s)
- Camille Guinemer
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Boeker
- Faculty of Medicine, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Bjoern Weiss
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Fuerstenau
- Copenhagen Business School, Copenhagen, Denmark.,School of Business & Economics, Freie Universität Berlin, Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Akira-Sebastian Poncette
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
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Fusaro MV, Becker C, Miller D, Hassan IF, Scurlock C. ICU Telemedicine Implementation and Risk-Adjusted Mortality Differences Between Daytime and Nighttime Coverage. Chest 2020; 159:1445-1451. [PMID: 33127432 DOI: 10.1016/j.chest.2020.10.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND ICU telemedicine augmentation has been associated with improvements in clinical and financial outcomes in many cases, but not all. Understanding this discrepancy is of interest given the clinical impact and intervention cost. A recent meta-analysis noted an association with mortality reduction and standardized mortality ratio (SMR) before ICU telemedicine implementation of > 1. RESEARCH QUESTION Does ICU telemedicine implementation affect adjusted mortality outcomes? If so, in what context? STUDY DESIGN AND METHODS We performed a retrospective pre-post analysis comparing before vs after ICU telemedicine implementation on the outcome of risk-adjusted ICU mortality during am vs pm admissions as well as other objective measures of ICU telemedicine involvement. RESULTS One thousand five hundred eighty-one patient-stays and 14,584 patient-stays were available for analysis in the implementation period before vs after ICU telemedicine implementation, respectively. The average Acute Physiology and Chronic Health Evaluation (APACHE) IVa score was 46.6 vs 54.8 (P < .01) in the am group before ICU telemedicine implementation vs the am group after ICU telemedicine implementation, respectively. The average APACHE IVa score was 47.2 vs 56.3 (P < .01) in the pm group before ICU telemedicine implementation vs the pm group after ICU telemedicine implementation, respectively. Overall, the risk-adjusted ICU mortality was 8.7% before ICU telemedicine implementation vs 6.5% (P < .01) after implementation. When stratified by am and pm admission groups, no significant difference in risk-adjusted ICU mortality was seen in the am stratum. In the pm stratum, risk-adjusted mortality was 10.8% before ICU telemedicine implementation vs 7.0% (P < .01) after ICU telemedicine implementation. The preimplementation SMR in the am admission stratum was 0.95 vs 1.30 in the pm stratum. INTERPRETATION We found a reduction in risk-adjusted ICU mortality with implementation of ICU telemedicine driven predominantly within the pm admission group. The pm admission SMR was 1.30, which may suggest an association with SMR of > 1 before ICU telemedicine implementation and mortality reduction. Future studies should seek to confirm this finding and should explore other important ICU telemedicine outcomes in the context of observed-to-expected ratios.
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Affiliation(s)
- Mario V Fusaro
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, NY.
| | - Christian Becker
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, NY
| | - Daniel Miller
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, NY
| | - Ibrahim F Hassan
- Departments of Medicine and Genetic Medicine, Weill Cornell Medical College, Al Luqta St, Education City, Qatar
| | - Corey Scurlock
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY; Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, NY; Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, NY
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Miner H, Fatehi A, Ring D, Reichenberg JS. Clinician Telemedicine Perceptions During the COVID-19 Pandemic. Telemed J E Health 2020; 27:508-512. [PMID: 32946364 DOI: 10.1089/tmj.2020.0295] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Telemedicine utilization increased exponentially due to the coronavirus disease 2019 (COVID-19) pandemic. As a result, most clinicians now have experience with telemedicine. Questions/Purposes: We studied factors independently associated with a clinician desiring to continue telemedicine services after the COVID-19 pandemic. Secondarily, we sought factors independently associated with clinician satisfaction with the quality of care provided through telemedicine and factors associated with telemedicine platform preference by clinicians. Methods: A large multispecialty medical group of physicians were invited to complete a survey, including demographics, telemedicine experience, satisfaction with various elements of telemedicine encounters, desired features in a telemedicine platform, personality traits, and preferences. A total of 220 complete responses were analyzed. Results: A desire to continue offering telemedicine visits after the COVID-19 pandemic was independently associated with a higher satisfaction with the quality of telemedicine care, endorsement of the ease of performing a physical examination with telemedicine, belief that adaptability is an important element of being a clinician, and less preference for in-person work meetings over virtual meetings. Higher satisfaction with the quality of telemedicine care was associated with belief that adaptability is an important element of being a clinician, clinicians who identify as being more perceiving (value flexibility) than judging (value organization), providers from relatively urban counties, and those with less preference for in-person work meetings over virtual meetings. Clinicians ranked ease of use for patients and physicians as the most important features of telemedicine platforms. Conclusions: The observed association of clinician personality and interpersonal preferences with the appeal, satisfaction, and perceived effectiveness of telemedicine merit additional study. Early implementation of telemedicine might be easiest with clinicians that take pride in their adaptability and value a technology-based workstyle.
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Affiliation(s)
- Harrison Miner
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Jason S Reichenberg
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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Singh J, Green MB, Lindblom S, Reif MS, Thakkar NP, Papali A. Telecritical Care Clinical and Operational Strategies in Response to COVID-19. Telemed J E Health 2020; 27:261-268. [PMID: 32809920 DOI: 10.1089/tmj.2020.0186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: The cororavirus disease 19 (COVID-19) pandemic has strained intensive care unit (ICU) material and human resources to global crisis levels. The risks of staffing challenges and clinician exposure are of significant concern. One resource, telecritical care (TCC), has the potential to optimize efficiency, maximize safety, and improve quality of care provided amid large-scale disruptions, but its role in pandemic situations is only loosely defined. Planning and Preparation Phase: We propose strategic initiatives by which TCC may act as a force multiplier for pandemic preparedness in response to COVID-19, utilizing a tiered approach for increasing surge capacity needs. The goals involved usage of TCC to augment ICU capacity, optimize safety, minimize personal protective equipment (PPE) use, improve efficiencies, and enhance knowledge of managing pandemic response. Implementation Phase: A phased approach utilizing TCC would involve implementing remote capabilities across the enterprise to accomplish the goals outlined. The hardware and software needed for initial expansion to cover 275 beds included $956,670 for mobile carts and $173,106 for home workstations. Team role deployment and bedside clinical care centering around TCC as critical care capacity expand beyond 275 beds. Surge capacity was not reached during early phases of the pandemic in the region, allowing refinement of TCC during subsequent pandemic phases. Conclusions: Leveraging TCC facilitated pandemic surge planning but required redefinition of typical ICU staffing models. The design was meant to workforce efficiencies, reduce PPE use, and minimize health care worker exposure risk, all while maintaining quality care standards through an intensivist-led model. As health care operations resumed and states reopened, TCC is being used to support shifts in volume and critical care personnel during the pandemic evolution. The lessons applied may help health care systems through variable phases of the pandemic.
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Affiliation(s)
- Jaspal Singh
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA.,Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Michael B Green
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA
| | - Scott Lindblom
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA
| | - Michael S Reif
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA
| | - Nehal P Thakkar
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA
| | - Alfred Papali
- Atrium Health, Division of Pulmonary & Critical Care Medicine, Charlotte, North Carolina, USA.,Virtual Critical Care Services, Mint Hill, North Carolina, USA
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Arabi YM, Mallampalli R, Englert JA, Bosch NA, Walkey AJ, Al-Dorzi HM. Update in Critical Care 2019. Am J Respir Crit Care Med 2020; 201:1050-1057. [PMID: 32176850 DOI: 10.1164/rccm.202002-0285up] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rama Mallampalli
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State Wexner Medical, Center, Columbus, Ohio; and
| | - Joshua A Englert
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State Wexner Medical, Center, Columbus, Ohio; and
| | - Nicholas A Bosch
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Allan J Walkey
- Department of Medicine, Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Hasan M Al-Dorzi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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36
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Egert M, Steward JE, Sundaram CP. Machine Learning and Artificial Intelligence in Surgical Fields. Indian J Surg Oncol 2020; 11:573-577. [PMID: 33299275 DOI: 10.1007/s13193-020-01166-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) have the potential to improve multiple facets of medical practice, including diagnosis of disease, surgical training, clinical outcomes, and access to healthcare. There have been various applications of this technology to surgical fields. AI and ML have been used to evaluate a surgeon's technical skill. These technologies can detect instrument motion, recognize patterns in video recordings, and track the physical motion, eye movements, and cognitive function of the surgeon. These modalities also aid in the advancement of robotic surgical training. The da Vinci Standard Surgical System developed a recording and playback system to help trainees receive tactical feedback to acquire more precision when operating. ML has shown promise in recognizing and classifying complex patterns on diagnostic images and within pathologic tissue analysis. This allows for more accurate and efficient diagnosis and treatment. Artificial neural networks are able to analyze sets of symptoms in conjunction with labs, imaging, and exam findings to determine the likelihood of a diagnosis or outcome. Telemedicine is another use of ML and AI that uses technology such as voice recognition to deliver health care remotely. Limitations include the need for large data sets to program computers to create the algorithms. There is also the potential for misclassification of data points that do not follow the typical patterns learned by the machine. As more applications of AI and ML are developed for the surgical field, further studies are needed to determine feasibility, efficacy, and cost.
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Affiliation(s)
- Melissa Egert
- Department of Urology, Indiana University School of Medicine, 535 N Barnhill Drive, Suite 150, Indianapolis, IN 46202 USA
| | - James E Steward
- Department of Urology, Indiana University School of Medicine, 535 N Barnhill Drive, Suite 150, Indianapolis, IN 46202 USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, 535 N Barnhill Drive, Suite 150, Indianapolis, IN 46202 USA
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37
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Connecting the Docs: Telemedicine Support during In-Hospital Cardiac Arrest Resuscitation. Ann Am Thorac Soc 2020; 17:278-279. [PMID: 32108502 DOI: 10.1513/annalsats.201912-884ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Background: The current coronavirus disease 2019 pandemic is causing significant strain on ICUs worldwide. Initial and subsequent regional surges are expected to persist for months and potentially beyond. As a result of this, as well as the fact that ICU provider staffing throughout the United States currently operate at or near capacity, the risk for severe and augmented disruption in delivery of care is very real. Thus, there is a pressing need for proactive planning for ICU staffing augmentation, which can be implemented in response to a local surge in ICU volumes. Methods: We provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists at a system-wide level. Results: The protocol was designed and implemented by the University of Pittsburgh Medical Center’s Integrated ICU Service Center and was rolled out to the entire health system, a 40-hospital system spanning Pennsylvania, New York, and Maryland. Surge staffing models were developed using this framework to assure that local needs were balanced with system resource supply, with rapid enhancement and expansion of tele-ICU capabilities. Conclusions: The ICU pandemic surge staffing algorithm, using a tiered-provider strategy, was able to be used by hospitals ranging from rural community to tertiary/quaternary academic medical centers and adapted to meet specific needs rapidly. The concepts and general steps described herein may serve as a framework for hospital and other hospital systems to maintain staffing preparedness in the face of any form of acute patient volume surge.
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Subramanian S, Pamplin JC, Hravnak M, Hielsberg C, Riker R, Rincon F, Laudanski K, Adzhigirey LA, Moughrabieh MA, Winterbottom FA, Herasevich V. Tele-Critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee. Crit Care Med 2020; 48:553-561. [PMID: 32205602 DOI: 10.1097/ccm.0000000000004190] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In 2014, the Tele-ICU Committee of the Society of Critical Care Medicine published an article regarding the state of ICU telemedicine, one better defined today as tele-critical care. Given the rapid evolution in the field, the authors now provide an updated review. DATA SOURCES AND STUDY SELECTION We searched PubMed and OVID for peer-reviewed literature published between 2010 and 2018 related to significant developments in tele-critical care, including its prevalence, function, activity, and technologies. Search terms included electronic ICU, tele-ICU, critical care telemedicine, and ICU telemedicine with appropriate descriptors relevant to each sub-section. Additionally, information from surveys done by the Society of Critical Care Medicine was included given the relevance to the discussion and was referenced accordingly. DATA EXTRACTION AND DATA SYNTHESIS Tele-critical care continues to evolve in multiple domains, including organizational structure, technologies, expanded-use case scenarios, and novel applications. Insights have been gained in economic impact and human and organizational factors affecting tele-critical care delivery. Legislation and credentialing continue to significantly influence the pace of tele-critical care growth and adoption. CONCLUSIONS Tele-critical care is an established mechanism to leverage critical care expertise to ICUs and beyond, but systematic research comparing different models, approaches, and technologies is still needed.
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Affiliation(s)
- Sanjay Subramanian
- Division of Critical Care Medicine, Department Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, Ft. Detrick, MD
- Uniformed Services University, Bethesda, MD
| | - Marilyn Hravnak
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Fred Rincon
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, PA
| | | | - M Anas Moughrabieh
- Department of Pulmonary and Critical Care, Wayne State University, Detroit, MI
| | - Fiona A Winterbottom
- Advanced Practice Provider, Pulmonary Critical Care Evidence-Based Practice Facilitator, The Center for EBP and Nursing Research Ochsner Health System, New Orleans, LA
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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40
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Acceptability and Perceived Utility of Telemedical Consultation during Cardiac Arrest Resuscitation. A Multicenter Survey. Ann Am Thorac Soc 2020; 17:321-328. [DOI: 10.1513/annalsats.201906-485oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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41
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Van Tiem JM, Friberg JE, Wilson JR, Fitzwater L, Blum JM, Panos RJ, Reisinger HS, Moeckli J. Utilized or Underutilized: A Qualitative Analysis of Building Coherence During Early Implementation of a Tele-Intensive Care Unit. Telemed J E Health 2020; 26:1167-1177. [PMID: 31928388 DOI: 10.1089/tmj.2019.0135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Generating, reading, or interpreting data is a component of Telemedicine-Intensive Care Unit (Tele-ICU) utilization that has not been explored in the literature. Introduction: Using the idea of "coherence," a construct of Normalization Process Theory, we describe how intensive care unit (ICU) and Tele-ICU staff made sense of their shared work and how they made use of Tele-ICU together. Materials and Methods: We interviewed ICU and Tele-ICU staff involved in the implementation of Tele-ICU during site visits to a Tele-ICU hub and 3 ICUs, at preimplementation (43 interviews with 65 participants) and 6 months postimplementation (44 interviews with 67 participants). Data were analyzed using deductive coding techniques and lexical searches. Results: In the early implementation of Tele-ICU, ICU and Tele-ICU staff lacked consensus about how to share information and consequently how to make use of innovations in data tracking and interpretation offered by the Tele-ICU (e.g., acuity systems). Attempts to collaborate and create opportunities for utilization were supported by quality improvement (QI) initiatives. Discussion: Characterizing Tele-ICU utilization as an element of a QI process limited how ICU staff understood Tele-ICU as an innovation. It also did not promote an understanding of how the Tele-ICU used data and may therefore attenuate the larger promise of Tele-ICU as a potential tool for leveraging big data in critical care. Conclusions: Shared data practices lay the foundation for Tele-ICU program utilization but raise new questions about how the promise of big data can be operationalized for bedside ICU staff.
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Affiliation(s)
- Jennifer M Van Tiem
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Julia E Friberg
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Jaime R Wilson
- The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Lynn Fitzwater
- VISN 10/Cincinnati Tele-ICU System, Cincinnati, Ohio, USA
| | - James M Blum
- Department of Anesthesiology, Atlanta VA Healthcare System, Atlanta, Georgia, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ralph J Panos
- VISN 10/Cincinnati Tele-ICU System, Cincinnati, Ohio, USA
| | - Heather Schacht Reisinger
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jane Moeckli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
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42
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Becker CD, Yang M, Fusaro M, Fry M, Scurlock CS. Optimizing Tele-ICU Operational Efficiency Through Workflow Process Modeling and Restructuring. Crit Care Explor 2019; 1:e0064. [PMID: 32166245 PMCID: PMC7063929 DOI: 10.1097/cce.0000000000000064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Little is known on how to best prioritize various tele-ICU specific tasks and workflows to maximize operational efficiency. We set out to: 1) develop an operational model that accurately reflects tele-ICU workflows at baseline, 2) identify workflow changes that optimize operational efficiency through discrete-event simulation and multi-class priority queuing modeling, and 3) implement the predicted favorable workflow changes and validate the simulation model through prospective correlation of actual-to-predicted change in performance measures linked to patient outcomes. SETTING Tele-ICU of a large healthcare system in New York State covering nine ICUs across the spectrum of adult critical care. PATIENTS Seven-thousand three-hundred eighty-seven adult critically ill patients admitted to a system ICU (1,155 patients pre-intervention in 2016Q1 and 6,232 patients post-intervention 2016Q3 to 2017Q2). INTERVENTIONS Change in tele-ICU workflow process structure and hierarchical process priority based on discrete-event simulation. MEASUREMENTS AND MAIN RESULTS Our discrete-event simulation model accurately reflected the actual baseline average time to first video assessment by both the tele-ICU intensivist (simulated 132.8 ± 6.7 min vs 132 ± 12.2 min actual) and the tele-ICU nurse (simulated 128.4 ± 7.6 min vs 123 ± 9.8 min actual). For a simultaneous priority and process change, the model simulated a reduction in average TVFA to 51.3 ± 1.6 min (tele-ICU intensivist) and 50.7 ± 2.1 min (tele-ICU nurse), less than the added simulated reductions for each change alone, suggesting correlation of the changes to some degree. Subsequently implementing both changes simultaneously resulted in actual reductions in average time to first video assessment to values within the 95% CIs of the simulations (50 ± 5.5 min for tele-intensivists and 49 ± 3.9 min for tele-nurses). CONCLUSIONS Discrete-event simulation can accurately predict the effects of contemplated multidisciplinary tele-ICU workflow changes. The value of workflow process and task priority modeling is likely to increase with increasing operational complexities and interdependencies.
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Affiliation(s)
- Christian D Becker
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Muer Yang
- Department of Operations and Supply Chain Management, University of St. Thomas, Opus College of Business, Minneapolis, MN
| | - Mario Fusaro
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Michael Fry
- Department of Operations, Business Analytics and Information Systems, University of Cincinnati, Carl H. Lindner College of Business, Cincinnati, OH
| | - Corey S Scurlock
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY
- Department of Anesthesiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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43
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Abstract
Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.
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44
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Becker CD, Dandy K, Gaujean M, Fusaro M, Scurlock C. Legal Perspectives on Telemedicine Part 2: Telemedicine in the Intensive Care Unit and Medicolegal Risk. Perm J 2019; 23:18.294. [PMID: 31496501 DOI: 10.7812/tpp/18.294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tele-intensive care unit (tele-ICU) implementation has been shown to improve clinical and financial outcomes. The expansion of this new care delivery model has outpaced the development of its accompanying regulatory framework. In the first part of this commentary we discussed legal and regulatory issues of telemedicine in general and expanded on tele-ICU implementation in particular. Major legal and regulatory barriers to expansion remain, including uncertainty regarding license portability and reimbursement. In this second part we discuss the effects of telemedicine implementation on the various aspects of medicolegal risk and risk mitigation, with a particular focus on tele-ICU. There is a paucity of legal data regarding the effect of tele-ICU implementation on medicolegal risk. We will therefore systematically discuss the effects of tele-ICU on the various root causes of medical error. Given the substantial capital and operational investment that must be undertaken to build and run a tele-ICU, any reduction in risk adds to the financial return on investment and further decreases barriers to implementation.
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Affiliation(s)
- Christian D Becker
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY.,Department of Medicine, Westchester Medical Center, Valhalla, NY.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York Medical College, Valhalla
| | - Katherine Dandy
- Law Firm of Brown, Gaujean, Kraus & Sastow, PLLC, White Plains, NY
| | - Max Gaujean
- Law Firm of Brown, Gaujean, Kraus & Sastow, PLLC, White Plains, NY
| | - Mario Fusaro
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY.,Department of Medicine, Westchester Medical Center, Valhalla, NY.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York Medical College, Valhalla
| | - Corey Scurlock
- eHealth Center, Westchester Medical Center Health Network, Valhalla, NY.,Department of Anesthesiology, Westchester Medical Center, Valhalla, NY.,Department of Anesthesiology, New York Medical College, Valhalla
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45
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Rincon TA, Bakshi V, Beninati W, Carpenter D, Cucchi E, Davis TM, Dreher J, Hiddleson C, Johansson MK, Katz AW, Olff C, Wansor EA, Ward D, Washington V, WinterBottom F, Kleinpell RM. Describing advanced practice provider roles within critical care teams with Tele-ICUs: Exemplars from seven US health systems. Nurs Outlook 2019; 68:5-13. [PMID: 31376986 DOI: 10.1016/j.outlook.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/11/2019] [Accepted: 06/15/2019] [Indexed: 11/19/2022]
Abstract
Telehealth is an acknowledged strategy to meet patient healthcare needs. In critical care settings, Tele-ICU's are expanding to deliver clinical services across a diverse spectrum of critically ill patients. The expansion of telehealth provides increased opportunities for advanced practice providers including advanced practice nurses and physician assistants; however, limited information on roles and models of care for advanced practice providers in telehealth exist. This article reviews current and evolving roles for advanced practice providers in telehealth in acute and critical care settings across 7 healthcare systems in the United States. The health system exemplars described in this article identify the important role of advanced practice providers in providing patient care oversight and in improving outcomes for acute and critically ill patients. As telehealth continues to expand, additional opportunities will lead to novel roles for advanced practice providers in the field of telehealth to assist with patient care management for subacute, acute, and critically ill patients.
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Affiliation(s)
- Teresa A Rincon
- Virtual Medicine Department, UMass Memorial Health Care, Worcester, MA.
| | - Vishal Bakshi
- Emory Critical Care Center, Emory Healthcare, Atlanta, GA
| | - William Beninati
- Intermountain Healthcare Connect, TeleCritical Care, Salt Lake City, UT
| | - Dawn Carpenter
- Graduate School of Nursing, UMass Medical School, Worcester, MA
| | - Eric Cucchi
- UMass Memorial Health Care, Critical Care Operations, Worcester, MA
| | | | - Jennifer Dreher
- Veteran's Health Administration, Veterans Integrated Services Network (VISN 10 Tele-ICU), Cincinnati, OH
| | | | | | - Adam W Katz
- UMass Memorial Health Care, Critical Care Operations, Worcester, MA
| | - Carol Olff
- John Muir Health, Concord Medical Center, Concord, CA
| | | | - Denise Ward
- Intermountain Healthcare Connect, TeleCritical Care, Salt Lake City, UT
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46
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Lee JT, Kerlin MP. ICU Telemedicine and the Value of Qualitative Research for Organizational Innovation. Am J Respir Crit Care Med 2019; 199:935-936. [PMID: 30433813 PMCID: PMC6467316 DOI: 10.1164/rccm.201811-2074ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jessica T Lee
- 1 Palliative and Advanced Illness Research Center Pulmonary, Allergy, and Critical Care Division and.,2 Leonard Davis Institute of Health Economics The Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
| | - Meeta Prasad Kerlin
- 1 Palliative and Advanced Illness Research Center Pulmonary, Allergy, and Critical Care Division and.,2 Leonard Davis Institute of Health Economics The Perelman School of Medicine of the University of Pennsylvania Philadelphia, Pennsylvania
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47
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Darby JL, Davis BS, Barbash IJ, Kahn JM. An administrative model for benchmarking hospitals on their 30-day sepsis mortality. BMC Health Serv Res 2019; 19:221. [PMID: 30971244 PMCID: PMC6458755 DOI: 10.1186/s12913-019-4037-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/24/2019] [Indexed: 12/29/2022] Open
Abstract
Background Given the increased attention to sepsis at the population level there is a need to assess hospital performance in the care of sepsis patients using widely-available administrative data. The goal of this study was to develop an administrative risk-adjustment model suitable for profiling hospitals on their 30-day mortality rates for patients with sepsis. Methods We conducted a retrospective cohort study using hospital discharge data from general acute care hospitals in Pennsylvania in 2012 and 2013. We identified adult patients with sepsis as determined by validated diagnosis and procedure codes. We developed an administrative risk-adjustment model in 2012 data. We then validated this model in two ways: by examining the stability of performance assessments over time between 2012 and 2013, and by examining the stability of performance assessments in 2012 after the addition of laboratory variables measured on day one of hospital admission. Results In 2012 there were 115,213 sepsis encounters in 152 hospitals. The overall unadjusted mortality rate was 18.5%. The final risk-adjustment model had good discrimination (C-statistic = 0.78) and calibration (slope and intercept of the calibration curve = 0.960 and 0.007, respectively). Based on this model, hospital-specific risk-standardized mortality rates ranged from 12.2 to 24.5%. Comparing performance assessments between years, correlation in risk-adjusted mortality rates was good (Pearson’s correlation = 0.53) and only 19.7% of hospitals changed by more than one quintile in performance rankings. Comparing performance assessments after the addition of laboratory variables, correlation in risk-adjusted mortality rates was excellent (Pearson’s correlation = 0.93) and only 2.6% of hospitals changed by more than one quintile in performance rankings. Conclusions A novel claims-based risk-adjustment model demonstrated wide variation in risk-standardized 30-day sepsis mortality rates across hospitals. Individual hospitals’ performance rankings were stable across years and after the addition of laboratory data. This model provides a robust way to rank hospitals on sepsis mortality while adjusting for patient risk. Electronic supplementary material The online version of this article (10.1186/s12913-019-4037-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Darby
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Billie S Davis
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ian J Barbash
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jeremy M Kahn
- CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA. .,Critical Care Medicine and Health Policy & Management, University of Pittsburgh, Scaife Hall Room 602-B, 3550 Terrace Street, Pittsburgh, PA, 15221, USA.
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48
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Becker CD, Fusaro MV, Scurlock C. Deciphering factors that influence the value of tele-ICU programs. Intensive Care Med 2019; 45:1046-1051. [PMID: 30874824 DOI: 10.1007/s00134-019-05591-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Christian D Becker
- eHealth Center, Westchester Medical Center Health Network, Taylor Pavilion, Room O102, 100 Woods Road, Valhalla, NY, 10595, USA. .,Department of Medicine, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA. .,Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, USA.
| | - Mario V Fusaro
- eHealth Center, Westchester Medical Center Health Network, Taylor Pavilion, Room O102, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Medicine, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, USA
| | - Corey Scurlock
- eHealth Center, Westchester Medical Center Health Network, Taylor Pavilion, Room O102, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Anesthesiology, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.,Department of Anesthesiology, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, USA
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