TeleICU Interdisciplinary Care Teams

Welsh, Cindy; Rincon, Teresa; Berman, I.; Bobich, Tom; Brindise, Theresa; Davis, Theresa

doi:10.1016/j.ccc.2019.02.008

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…The most common bedside consultations were on topics related to ventilation settings, ventilator weaning, sedation, and early rehabilitation. The optimal structure of the Tele-ICU team is one that leverages expert clinical knowledge to address the needs of critically ill patients, regardless of hospital location or availability of on-site staff [ 17 ]. From this point of view, it is suggested that the Tele-ICU system effectively utilized the expertise of the Tele-ICU physician.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study

et al. 2023

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Background The telemedicine intensive care unit (Tele-ICU) is defined as a system in which intensive care professionals remotely provide care to critically ill patients and support the on-site staff in the intensive care unit (ICU) using secured audio–video and electronic links. Although the Tele-ICU is expected to resolve the shortage of intensivists and reduce the regional disparities in intensive care resources, the efficacy has not yet been evaluated in Japan because of a lack of clinically available system. Methods This was a single-center, historical comparison study in which the impact of the Tele-ICU on ICU performance and changes in workload of the on-site staff were evaluated. The Tele-ICU system developed in the United States was used. Data for 893 adult ICU patients before the Tele-ICU implementation and for all adult patients registered in the Tele-ICU system from April 2018 to March 2020 were abstracted and included. We investigated ICU and hospital mortality and length of stay and ventilation duration after the Tele-ICU implementation in each ICU, and compared between pre and post implementation and changes over time. We also assessed physician workload as defined by the frequency and duration of access to the electronic medical record (EMR) of the targeted ICU patients. Results After the Tele-ICU implementation 5438 patients were included. In unadjusted data pre/post study showed significant decreases in ICU (8.5–3.8%) and hospital (12.4–7.7%) mortality and ICU length of stay (p < 0.001), and those values were maintained for 2 years. In data stratified by predicted hospital mortality, ICU and hospital actual mortality in high and medium risk patients decreased significantly after the implementation. Ventilation duration was shortened (p < 0.007). Access frequency of the on-site physicians decreased by 25%, and the decrease occurred in the daytime shift and in the physicians with 3–15 years of work experience. Conclusions Our study showed the Tele-ICU implementation was associated with lower mortality, especially in medium and high risk patients, and decreased EMR-related tasks of on-site physicians. These results suggest that the Tele-ICU could be a solution of the shortage of intensivists and regional disparities for intensive care.

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Section: Discussionmentioning

confidence: 99%

An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study

et al. 2023

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“…Decentralized systems (also named virtual consultant ) allow one-on-one connections without the need for central coordination [ 3 ]. Second, staff allocation and availability can vary (eg, day presence or 24/7) [ 8 ]. Third, the mode of interaction between telemedicine teams and bedside staff may allow various levels of staff reactivity (reactive vs proactive to patient alerts) and intervention scope (minimal intervention allowed vs full discretion on patient care) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…We define context of implementation as the clinical structures and processes where telemedical interventions are deployed [ 16 ]. It has been suggested that the efficacy of tele-ICU interventions is dependent on where and how they are deployed in the organization [ 6 , 10 ], and there is a need for broadening the understanding of the organizational factors influencing the efficacy of tele-ICU interventions [ 8 ]. We found that no previous study has attempted to provide a review of current evidence by systematically analyzing the implementation setup and context.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine in Intensive Care Units: Scoping Review

Guinemer¹,

Boeker²,

Fürstenau³

et al. 2021

J Med Internet Res

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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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“…Third, staffing patterns and care team composition vary across systems. Tele-ICUs accommodate different intensivist presence times at the bedside during the day, night, or weekend, based on the needs and resources of the ICU and tele-ICU units [14]. The wider care team composition also presents some differences between tele-ICUs.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine in Intensive Care Units: Protocol for a Scoping Review

Guinemer¹,

Boeker²,

Weiß³

et al. 2020

JMIR Res Protoc

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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 contributio...

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TeleICU Interdisciplinary Care Teams

Cited by 9 publications

References 24 publications

An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study

An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study

Telemedicine in Intensive Care Units: Scoping Review

Telemedicine in Intensive Care Units: Protocol for a Scoping Review

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