Prioritizing the organization and management of intensive care services in the United States: The PrOMIS Conference*

Barnato, Amber E.; Kahn, Jeremy M.; Rubenfeld, Gordon D.; McCauley, Kathleen M.; Fontaine, Dorrie K.; Frassica, Joseph J.; Hubmayr, Rolf D.; Jacobi, Judith; Brower, Roy G.; Chalfin, Donald B.; Sibbald, William J.; Asch, David A.; Kelley, Mark A.; Angus, Derek C.

doi:10.1097/01.ccm.0000259535.06205.b4

Cited by 100 publications

(71 citation statements)

References 39 publications

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“…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).…”

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confidence: 99%

The Costs of Critical Care Telemedicine Programs

Kumar

Falk

Bonello

et al. 2013

Chest

Self Cite

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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confidence: 99%

The Costs of Critical Care Telemedicine Programs

Kumar

Falk

Bonello

et al. 2013

Chest

Self Cite

110

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“…Up to 6 million adult patients are admitted annually to intensive care units (ICU) across the United States [1,2] . This environment is influenced by factors such as intense cognitive demands, multiple communication channels, interruptions, multitasking, and complex organ support devices [3,4] .…”

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confidence: 99%

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

Dziadzko¹,

Ahmed²,

Tiong³

et al. 2016

WJCCM

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AIM:To examine the feasibility and validity of electronic generation of quality metrics in the intensive care unit (ICU). METHODS:This minimal risk observational study was performed at an academic tertiary hospital. The Critical Care Independent Multidisciplinary Program at Mayo Clinic identified and defined 11 key quality metrics. These metrics were automatically calculated using ICU DataMart, a near-real time copy of all ICU electronic medical record (EMR) data. The automatic report was compared with data from a comprehensive EMR review by a trained investigator. Data was collected for 93 randomly selected patients admitted to the ICU during April 2012 (10% of admitted adult population). This study was approved by the Mayo Clinic Institution Review Board. RESULTS:All types of variables needed for metric calculations were found to be available for manual and electronic abstraction, except information for availability of free beds for patient-specific time-frames. There was 100% agreement between electronic and manual data abstraction for ICU admission source, admission service, and discharge disposition. The agreement between electronic and manual data abstraction of the time of ICU admission and discharge were 99% and 89%. The time of hospital admission and discharge were similar for both the electronically and manually abstracted datasets. The specificity of the electronically-generated report was 93% and 94% for invasive and non-invasive ventilation use in the ICU. One false-positive result for each type of ventilation was present. The specificity for ICU and in-hospital mortality was 100%. Sensitivity was 100% for all metrics. CONCLUSION:Our study demonstrates excellent accuracy of electronically-generated key ICU quality metrics. This validates the feasibility of automatic metric generation. Core tip: Meaningful use of electronic healthcare records (EHRs) requires quality measures. Many administrative reporting tools provided by current EHRs are based on insufficiently accurate data and thus of limited use. We examine the feasibility and the validity of electronic generation of institutional key intensive care unit (ICU) quality metrics using ICU DataMart, a near-real time relational database.Dziadzko MA, Thongprayoon C, Ahmed A, Tiong IC, Li M, Brown DR, Pickering BW, Herasevich V. Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use.

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“…This association likely has many causes, including differences in the adoption rate of evidence-based care (8), provider expertise/staffing models (7,9,10), and referral bias (11). Thus, various professional organizations are actively debating a tiered system of regionalization for patients with VDRF (12,13) that would be similar to existing systems in trauma and high-risk neonatology (14)(15)(16).…”

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Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

et al. 2017

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Rationale: Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.Objectives: To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.Methods: We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.Results: Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilatordependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics. Conclusions:In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resourceintensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilatordependent respiratory failure.

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Prioritizing the organization and management of intensive care services in the United States: The PrOMIS Conference*

Cited by 100 publications

References 39 publications

The Costs of Critical Care Telemedicine Programs

The Costs of Critical Care Telemedicine Programs

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

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