Measuring the Value of Romote ICU Monitoring

描述（由申请人提供）：对重症监护病房（icu）的护理质量有很大影响的是重症监护医生（重症监护医师）在icu的存在。高强度的重症监护人员配备（需要重症监护人员会诊或重症监护人员对所有患者进行检查的封闭ICU）与医院死亡率降低29%和ICU死亡率降低49%相关。然而，只有10- 15%的美国医院配备了高强度的重症监护人员，这主要是由于现有的重症监护人员短缺和日益严重的短缺。远程医疗是卫生信息技术的一种常见形式，已被用于通过远程icu为icu提供远程重症监护。唯一一项使用远程ICU进行远程监护的研究发现，与现场重症监护人员相比，降低了死亡率和住院时间。由于这项单一研究的局限性，对icu重症监护人员覆盖率的需求不断增长，重症监护人员短缺，以及远程icu可能的有效性，需要进行更多的研究。

DESCRIPTION (provided by the applicant): A powerful influence on the quality of care in intensive care units (ICUs) is the presence of critical care physicians (intensivists) in the unit. High-intensity intensivist staffing (required intensivist consultation or closed ICU where intensivists see all patients) is associated with a 29 percent reduction in hospital mortality and a 49 percent reduction in ICU mortality. However, only 10-15 percent of U.S. hospitals have high-intensity staffing by intensivists, primarily due to an existing and worsening shortage of intensivists. Telemedicine, a common form of health information technology, has been used to provide remote intensivist monitoring for ICUs via a tele-ICU. The only study of remote ICU monitoring with a tele-ICU found a reduction in mortality and length of stay comparable to on-site intensivist staffing. More research is needed because of limitations with this single study, the growing demand for intensivist coverage in ICUs, the shortage of intensivists, and the possible effectiveness of tele-ICUs. The specific aims of this study are: 1. To measure the effect of a tele-ICU on mortality, complications, and length of stay in ICUs in a tertiary care teaching hospital, and in seven community (including two "small") hospitals using a pre- and post-intervention study design. 2. To measure the cost-effectiveness of the tele-ICU. 3. To use human factors engineering techniques to determine how changes to the user interface of the tele-ICU may increase the value of the technology. 4. To measure changes in healthcare provider attitudes about teamwork and safety climate after implementation of the tele-ICU.