Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care
Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care
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DOI：
10.1097/00003246-200012000-00034
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发表时间：
2000-12-01
影响因子：
8.8
通讯作者：
Rubin, H
中科院分区：
文献类型：
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作者：
Rosenfeld, BA;Dorman, T;Rubin, H
目标：重症监护病房 (ICU) 在住院人数和资源消耗中所占的比例越来越大。不良事件在 ICU 患者中很常见，导致高死亡率和高费用。尽管有证据表明重症监护医师管理 ICU 患者时并发症和死亡率会降低，但全国范围内这些专家的严重短缺使得大多数医院无法实施全天候、现场重症监护模式。需要采取替代策略，为危重病人提供专业知识和主动、持续的护理。我们评估了使用远程医疗作为实现 24 小时重症监护和改善临床结果的一种手段的可行性。设计：观察性时间序列三重队列研究。设置：学术附属社区医院的 10 个床位的外科 ICU。患者：所有在研究期间整个 ICU 住院的患者。干预措施：制定了为期 16 周的连续重症监护计划 在外科 ICU，在干预之前，可以进行重症监护医师会诊，但没有现场重症监护医师。重症医生在干预期间使用远程监控方法（视频会议和基于计算机的数据传输）提供管理，以获取临床信息并与现场人员进行沟通。为了评估远程管理计划的益处，将干预期间的临床和经济表现与实施前一年内的两个 16 周期间进行比较。测量和主要结果：在 3 个研究期间测量 ICU 和医院死亡率（观察到的和急性生理学和慢性健康评估疾病，严重程度调整）、ICU 并发症、ICU 和医院住院时间以及 ICU 和医院费用。与基线期一和二相比，干预期间严重程度调整后的 ICU 死亡率分别下降了 68% 和 46%，严重程度调整后的医院死亡率分别下降了 33% 和 30%，ICU 并发症发生率分别下降了 44% 和 50%。 ICU 住院时间分别下降了 34% 和 30%，ICU 费用分别下降了 33% 和 36%。节省的石膏与较低的并发症发生率相关。结论：技术支持的远程护理可用于提供持续的 ICU 患者管理并实现改善的临床和经济结果。这项干预措施的成功表明，在无法获得现场重症监护的情况下，远程护理计划可以提供一种提高护理质量并降低成本的方法。
Objective: Intensive care units (ICUs) account far an increasing percentage of hospital admissions and resource consumption. Adverse events are common in ICU patients and contribute to high mortality rates and costs. Although evidence demonstrates reduced complications and mortality when intensivists manage ICU patients, a dramatic national shortage of these specialists precludes most hospitals from implementing an around-the-clock, on-site intensivist care model. Alternate strategies are needed to bring expertise and proactive, continuous care to the critically ill. We evaluated the feasibility of using telemedicine as a means of achieving 24-hr intensivist oversight and improved clinical outcomes.Design: Observational time series triple cohort study.Setting: A ten-bed surgical ICU in an academic-affiliated community hospital.Patients: All patients whose entire ICU stay occurred within the study periods.Interventions: A 16-wk program of continuous intensivist oversight was instituted in a surgical ICU, where before the intervention, intensivist consultation was available but there were no on-site intensivists. Intensivists provided management during the intervention using remote monitoring methodologies (video conferencing and computer-based data transmission) to obtain clinical information and to communicate with on-site personnel. To assess the benefit of the remote management program, clinical and economic performance during the intervention were compared with two 16-wk periods within the year before the intenrentian,Measurements and Main Results: ICU and hospital mortality (observed and Acute Physiology and Chronic Health Evaluation ill, severity-adjusted), ICU complications, ICU and hospital length-of-stay, and ICU and hospital costs were measured during the 3 study periods. Severity-adjusted ICU mortality decreased during the intervention period by 68% and 46%, compared with baseline periods one and two, respectively, Severity-adjusted hospital mortality decreased by 33% and 30%, and the incidence of ICU complications was decreased by 44% and 50%. ICU length of stay decreased by 34% and 30%, and ICU costs decreased by 33% and 36%, respectively. The cast savings were associated with a lower incidence of complications.Conclusions: Technology-enabled remote care can be used to provide continuous ICU patient management and to achieve improved clinical and economic outcomes. This intervention's success suggests that remote care programs may provide a means of improving quality of care and reducing costs when on-site intensivist coverage is not available.