Clinical and economic outcomes of the electronic intensive care unit: Results from two community hospitals*

Morrison, Jeanette; Cai, Qian; Davis, Nancy; Yan, Yan; Berbaum, Michael L.; Ries, Michael; Solomon, Glen D.

doi:10.1097/ccm.0b013e3181b78fa8

Cited by 130 publications

(94 citation statements)

References 14 publications

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“…28,34 Only two (11%) studies and expansion seems likely. 7 Despite rapid adoption, reported effectiveness of tele-ICU coverage has varied across studies, [8][9][10][11] and studies often have neglected to address tele-ICU impact on staff. Staff impact is important as evidenced by a report of one hospital system that dropped tele-ICU coverage after 2 years.…”

Section: Description Of Studiesmentioning

confidence: 99%

Staff Acceptance of Tele-ICU Coverage

Young

Chan

Cram

2011

Chest

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A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced length of stay, 1 only one-third of critically ill patients receive intensivist care, and the shortfall is projected to worsen. 2 As a result, hospitals increasingly rely on tele-ICU coverage. 3 For the purposes of this article, we defi ne tele-ICU coverage as the application of telemedicine 4 to in-hospital critical care units, thereby encompassing an array of technologies of varying complexity 5,6 that allow physical ICUs to access critical care experts in real time.At the present time, it is estimated that 10% of US hospitals use some form of tele-ICU coverage, Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU confi guration, methodology, participants, and fi ndings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by . 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.

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Section: Description Of Studiesmentioning

confidence: 99%

Staff Acceptance of Tele-ICU Coverage

Young

Chan

Cram

2011

Chest

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“…[23][24][25][26][27][28][29][30] Because each study was missing one or more important data elements (e-Appendix 2), we contacted the authors of each study in an effort to obtain additional data; all but two of the authors responded, but none were able to provide additional data.…”

Section: For Editorial Comment See Pagementioning

confidence: 99%

“…Six studies presented data concerning the impact of tele-ICUs on hospital variable costs ( Table 3 ). [23][24][25][28][29][30] After tele-ICU implementation, studies with vendor affi liation reported a cost savings of $2,600 to $3,000 per patient and suggested that tele-ICUs increased hospital profi ts by $1,000 to $4,000 per patient. 23,25,28 Studies without vendor affi liation reported no variable cost savings and suggested increased hospital costs after implementation.…”

Section: Tele-icu Costsmentioning

confidence: 99%

“…23,25,27,28 Five studies implemented a commercial telemedicine system from a common vendor, but it was not reported if they concurrently implemented the vendor's CIS. 25,[27][28][29][30] None of the studies reported the availability of an EHR. Seven studies involved community hospitals where intensivists were either not available or only served as a consultative role for the primary physician.…”

Section: Literature Reviewmentioning

confidence: 99%

“…[24][25][26][27][28][29][30] Finally, only fi ve of the studies using real-time videoconferencing and monitoring equipment were monitoring patients 24 h/d. 23,25,[28][29][30] …”

Section: Literature Reviewmentioning

confidence: 99%

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The Costs of Critical Care Telemedicine Programs

Kumar

Falk

Bonello

et al. 2013

Chest

110

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ICUs deliver focused care to critically ill patients; but despite advances in ICU care, mortality rates remain high and vary significantly. 1,2 There is an increased effort to improve patient outcomes by providing dedicated intensivist staffi ng in all ICUs and promoting adoption of evidence-based therapies. [3][4][5][6][7][8] Access to intensivists has been hampered by an array of factors, most notably the limited supply of intensivists, particularly for smaller hospitals and rural geographic regions. [9][10][11] To improve the quality of critical care and extend the reach of the current intensivist workforce, at least 40 health-care systems in the United States have implemented telemedicine programs in ICUs (tele-ICUs). [12][13][14][15] Tele-ICUs typically combine real-time videoconferencing, telemetry, and electronic health records (EHRs). A tele-ICU allows physician and nurse intensivists located in a centralized monitoring center to monitor and care for patients in multiple distant ICUs. 16,17 Although the tele-ICU concept may be similar across facilities, the technology and associated treatment protocols (eg, ventilator protocols, sepsis management, best practice protocols) can vary signifi cantly across Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identifi ed eight studies reporting tele-ICU costs. These studies suggested combined implementation and fi rst year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and fi rst year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions:The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profi ts is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.

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Editor's Correspondence

2010

Arch Intern Med

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Clinical and economic outcomes of the electronic intensive care unit: Results from two community hospitals*

Abstract: In our study of >4000 patients representing two community hospitals, we did not find a reduction in mortality, length of stay, or hospital cost attributable to the introduction of the eICU.

Cited by 130 publications

References 14 publications

Staff Acceptance of Tele-ICU Coverage

Staff Acceptance of Tele-ICU Coverage

The Costs of Critical Care Telemedicine Programs

Editor's Correspondence

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