Clinical and economic outcomes of the electronic intensive care unit: Results from two community hospitals
Clinical and economic outcomes of the electronic intensive care unit: Results from two community hospitals
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DOI：
10.1097/ccm.0b013e3181b78fa8
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发表时间：
2010-01-01
影响因子：
8.8
通讯作者：
Solomon, Glen
中科院分区：
文献类型：
--
作者：
Morrison, Jeanette L.;Cai, Qian;Solomon, Glen
目的：为了确定远程医疗系统，电子重症监护病房（eICU），ICU的影响，和非ICU死亡率，总死亡率，总和ICU特定的住院时间，总医院成本在两个community hospital.Design：观察性研究，一个基线期和两个比较期（eICU波1和eICU波2）。每个时间段为4个月的持续时间。设置：四个ICU从两个社区医院在大都市芝加哥地区。第一医院是一家拥有610张床位的教学医院，拥有3个成人ICU（10张床位的内科ICU，10张床位的心脏ICU和14张床位的外科ICU）。第二医院是一家拥有185张床位的非教学医院，有一个10张床位的内科/外科混合ICU。患者：所有18岁或以上的患者，在指定的时间段内ICU住院至少4小时。干预措施：eICU于2003年4月在两家医院实施。测量和主要结果：测量死亡率、住院时间和总费用。年龄、性别、人种/种族、创伤状态、急性生理学和慢性健康评估III评分以及医生对eICU的利用率作为协变量纳入分析，共纳入4088例患者（基线时1371例，eICU第一波1287例，eICU第二波1430例）。eICU对ICU/非ICU/总死亡率或住院时间没有显著影响。ICU住院时间随着时间的推移而增加，并且与医生对eICU的利用率较高相关。虽然总住院费用随着时间的推移而增加，但对于那些医生只允许低水平eICU参与的患者，增加率更高。结论：在我们对代表两家社区医院的>4000例患者的研究中，我们没有发现死亡率、住院时间或住院费用因引入eICU而减少。(Crit Care Med 2010; 38：2-8）
Objective: To determine the impact of a telemedicine system, the electronic intensive care unit (eICU), on ICU, and non-ICU mortality, total mortality, total and ICU-specific length of stay, and total hospital cost at two community hospitals.Design: Observational study with one baseline period and two comparison periods (eICU wave one and eICU wave two). Each time period was 4 months in duration.Setting: Four ICU from two community hospitals in the metropolitan Chicago area. Hospital one is a 610-bed teaching hospital with three adult ICU (ten-bed medical ICU, ten-bed cardiac ICU, and 14-bed surgical ICU). Hospital two is a 185-bed nonteaching hospital with a ten-bed mixed medical/surgical ICU.Patients: All patients 18 yrs or older with an ICU stay of at least 4 hrs during the specified time period were included.Interventions: The eICU was implemented at both hospitals in April 2003.Measurements and Main Results: Mortality, length of stay, and total cost were measured. Age, gender, race/ethnicity, trauma status, Acute Physiology and Chronic Health Evaluation III score, and physician utilization of the eICU were included as covariates.Included in the analysis were 4088 patients (1371 at baseline, 1287 in eICU wave one, and 1430 in eICU wave two). The eICU did not have a significant effect on ICU/non-ICU/total mortality or hospital length of stay. ICU length of stay increased over time and was associated with higher physician utilization of the eICU. Although total hospital costs increased over time, the rate of increase was steeper for those patients whose physicians permitted only a low level of eICU involvement.Conclusions: 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. (Crit Care Med 2010; 38:2-8)