Measuring the Value of Romote ICU Monitoring

描述（由申请人提供）：重症监护室（ICU）中重症监护医生（重症监护医师）的存在对重症监护室（ICU）的护理质量有很大影响。 高强度的重症监护人员配备（需要重症监护会诊或重症监护人员看到所有患者的封闭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%的美国医院拥有高强度的重症监护人员，主要是由于重症监护人员短缺。 远程医疗是一种常见的健康信息技术，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ICU监测的研究发现，与现场重症监护人员配置相比，死亡率和住院时间减少。 由于这项单一研究的局限性，对ICU重症监护覆盖率的需求不断增长，重症监护医生的短缺以及远程ICU的可能有效性，需要进行更多的研究。 这项研究的具体目标是： 1.采用干预前和干预后研究设计，测量远程ICU对三级护理教学医院和7家社区医院（包括2家“小型”医院）ICU死亡率、并发症和住院时间的影响。 2.衡量远程ICU的成本效益。 3.使用人因工程技术来确定远程ICU用户界面的变化如何增加技术价值。 4.测量实施远程ICU后医疗保健提供者对团队合作和安全氛围的态度变化。

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.