The Impact of Remote ICU Monitoring on Patient Outcomes and Processes of Care

远程 ICU 监测对患者治疗结果和护理过程的影响

• 批准号: 8182125
• 负责人: Peter M Cram
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182125
• 关键词: Administrator; Adoption; Advocate; Businesses; Calendar; Caring; Catheter-related bloodstream infection; Clinical; Clinical Data; Collaborations; Computerized Medical Record; Consultations; Control Groups; Costs and Benefits; Critical Care; Critical Illness; Data; Deterioration; Diagnostic; Distant; Evaluation; Frequencies; Funding; Health Resources; Hospital Mortality; Hospitals; Individual; Intensive Care Units; Investigation; Laboratories; Leadership; Length of Stay; Maintenance; Medicine; Methods; Monitor; Natural experiment; Nature; Nurses; Outcome; Patient Monitoring; Patients; Physicians; Pneumonia; Policy Maker; Process; Provider; Recommendation; Recruitment Activity; Relative (related person); Request for Proposals; Research Personnel; Rural Health; Rural Hospitals; Schedule; Services; Site; Solutions; Speed; System; Taxonomy; Technology; Testing; Therapeutic; Training; Variant; Ventilator; Veterans; Videoconferences; Videoconferencing; Writing; base; clinical care; cohort; cost; group intervention; health administration; hemodynamics; improved; meetings; mortality; programs; public-private partnership

Background: There is growing appreciation that the staffing of intensive care units (ICUs) by physicians trained in critical care medicine (intensivists) can result in improved patient outcomes. Intensivist staffing of ICUs has now been endorsed and advocated by a number of high-profile public and private partnerships. However adoption of intensivist staffing by hospitals has been hampered by an array of factors including a shortage of intensivist physicians. Recruiting and retaining intensivists may be particularly challenging for smaller rural hospitals including many smaller facilities within the Veterans Health Administration (VA). In an effort to overcome a lack of available intensivists a growing number of hospitals have installed remote ICU monitoring systems. These systems typically combine high-speed videoconferencing with features of an electronic medical record (EMR) to connect the clinical care team and patients at the remote (physical) ICUs to intensivist physicians and nurses at a central monitoring center; using this technology it is possible for a single intensivist and two or three nurses to monitor upwards of one hundred patients distributed across multiple physical ICUs. Staff at the monitoring center can check vital signs and laboratory tests, write orders, and communicate via videoconference with the on-site clinical care teams at the physical ICUs about changes in the condition of individual patients. Despite rapid adoption of remote ICU monitoring by hospitals, rigorous empirical data about the impact of these systems are extremely limited. Objectives: The objective of this study is to take advantage of a unique natural experiment that will occur with the implementation of a remote ICU monitoring system in the eight ICUs (seven hospitals) within VISN 23 during calendar year 2010. Our primary objective will be to examine the impact of remote ICU monitoring on patient outcomes including mortality, ventilator acquired pneumonia, and ICU length of stay. Our secondary objectives are to develop a taxonomy for describing the nature of the recommendations made by the central monitoring center and to evaluate the cost of implementing the ICU monitoring system. Methods: This study will use a mixed-methods approach. First, we will use validated VA administrative and clinical data to assess the impact of remote monitoring on patient mortality, length of stay, and selected intermediate patient outcomes including ventilator acquired pneumonia (VAP) and catheter-related bloodstream infections (CR-BSI). For these analyses the intervention group will consist of consecutive patients admitted to the eight ICUs within VISN-23 where the remote ICU monitoring system will be implemented. The control group will consist of a cohort of patients admitted to eight control ICUs outside of VISN-23 that will not receive remote monitoring and are selected by propensity score matching. Second, we will develop a taxonomy for describing the nature of the recommendations made by the monitoring center staff and then use the taxonomy to characterize the types and relative frequency of therapeutic and diagnostic recommendations. Third, we will examine the start-up and maintenance costs associated with the implementation of the remote ICU monitoring program. Impact on VA: This evaluation will allow clinicians and administrators within the VA to understand the benefits and costs of implementing a remote ICU monitoring program.

背景：人们越来越认识到重症监护病房 (ICU) 的医生人员配备情况 接受过重症监护医学（重症监护）培训可以改善患者的治疗效果。人员密集配置 ICU 现已得到许多知名公共和私人合作伙伴的认可和倡导。 然而，医院采用重症监护人员配备受到一系列因素的阻碍，包括 重症医生短缺。招募和留住重症监护医师可能特别具有挑战性 较小的乡村医院，包括退伍军人健康管理局 (VA) 内的许多较小设施。在一个 为了克服重症监护室缺乏的问题，越来越多的医院安装了远程 ICU 监控系统。这些系统通常将高速视频会议与 电子病历 (EMR) 将临床护理团队和远程（物理） ICU 的患者连接起来 中央监测中心的重症医生和护士；使用这项技术，单个 重症监护室和两到三名护士负责监测分布在多个地点的一百名以上患者 物理 ICU。监控中心的工作人员可以检查生命体征和实验室测试、写指令以及 通过视频会议与实体 ICU 的现场临床护理团队沟通有关变化的信息 个别患者的情况。尽管医院迅速采用远程 ICU 监控，但严格 有关这些系统影响的经验数据极其有限。 目的：本研究的目的是利用一项独特的自然实验，该实验将在 在 VISN 23 内的八个 ICU（七家医院）实施远程 ICU 监控系统 2010 日历年。我们的主要目标是检查远程 ICU 监测对 患者结局包括死亡率、呼吸机获得性肺炎和 ICU 住院时间。我们的中学 目标是制定一个分类法来描述中央提出的建议的性质 监测中心并评估实施 ICU 监测系统的成本。 方法：本研究将使用混合方法。首先，我们将使用经过验证的 VA 管理和 评估远程监测对患者死亡率、住院时间和选定的影响的临床数据 患者中间结果，包括呼吸机获得性肺炎 (VAP) 和导管相关性肺炎 血流感染（CR-BSI）。对于这些分析，干预组将由连续的患者组成 入住 VISN-23 内的八个 ICU，将实施远程 ICU 监控系统。这 对照组将由入住 VISN-23 之外的八个对照 ICU 的患者组成，这些患者不会 接受远程监控并通过倾向评分匹配进行选择。其次，我们将开发一个 用于描述监测中心工作人员提出的建议的性质的分类法，然后使用 描述治疗和诊断建议的类型和相对频率的分类法。 第三，我们将检查与实施远程相关的启动和维护成本。 ICU 监测计划。 对 VA 的影响：该评估将使 VA 内的临床医生和管理人员了解其好处 以及实施远程 ICU 监控计划的成本。