Measuring the Value of Romote ICU Monitoring

描述(由申请人提供)：重症监护病房(ICU)的重症监护医生(重症监护室医生)的存在对重症监护病房(ICU)的护理质量有很大的影响。高强度的强化治疗人员配备(需要强化咨询或封闭的ICU，强化治疗人员看所有患者)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%的美国医院配备了强化医生的高强度工作人员，这主要是由于现有的且日益严重的强化医生短缺。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提供远程强化监测。唯一一项使用远程ICU进行远程ICU监测的研究发现，死亡率和住院时间的减少与现场重症监护室的人员配备相当。由于这一单一研究的局限性、ICU对强化治疗覆盖面的日益增长的需求、强化治疗的短缺以及远程ICU的可能有效性，需要进行更多的研究。 这项研究的具体目的是： 1.采用干预前和干预后研究设计，在一所三级护理教学医院和七家社区医院(包括两家“小型”医院)的ICU中，测量远程ICU对死亡率、并发症和住院时间的影响。 2.评价远程ICU的成本-效果。 3.使用人为因素工程学技术来确定远程重症监护病房用户界面的改变如何增加技术的价值。 4.测量医疗服务提供者在实施远程ICU后对团队合作和安全氛围的态度的变化。

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.