基于卫生系统的重症监护项目和新型远程 ICU：实施、成本和结构细节。

A health system-based critical care program with a novel tele-ICU: implementation, cost, and structure details.

机构信息

University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN; Critical Care and Acute Care Surgery Division, University of Minnesota, Minneapolis, MN; Pulmonary and Critical Care Division, University of Minnesota, Minneapolis, MN.

University of Minnesota Medical Center-Fairview, University of Minnesota, Minneapolis, MN; Pulmonary and Critical Care Division, University of Minnesota, Minneapolis, MN.

出版信息

J Am Coll Surg. 2014 Oct;219(4):676-83. doi: 10.1016/j.jamcollsurg.2014.04.015. Epub 2014 Jun 3.

DOI:10.1016/j.jamcollsurg.2014.04.015

PMID:25154668

Abstract

BACKGROUND

Improving the efficiency of critical care service is needed as the shortfall of intensivists is increasing. Standardizing clinical practice, telemedicine, and organizing critical care service at a health system level improves outcomes. We developed a health system Critical Care Program based at an academic medical center. The main feature of our program is an intensivist who shares on-site and telemedicine clinical responsibilities. Tele-ICU facilitates the standardization of high-quality critical care across the system. A common electronic medical record made the communications among the ICUs feasible. Combining faculty from medical and surgical critical care divisions increased the productivity of intensivists.

STUDY DESIGN

We retrospectively reviewed the administrative database data from 2011 and 2012, including mean census, number of transfers, age, sex, case mix index, mortality, readmissions, and financial data.

RESULTS

The Critical Care program has 106 adult ICU beds; 54 of those beds can be managed remotely using tele-ICU based at the main University hospital. The mean midnight census of the system for 2012 was 69.44 and total patient-days were 34,406. The capital cost of the tele-ICU was $1,186,220. The annual operational cost is $1,250,112 or $23,150 per monitored ICU-bed. Unadjusted mortality was 6.5% before and 4.9% after implementation (p < 0.0002).

CONCLUSIONS

We describe a novel health system level ICU program built using "off the shelf" technology based on a large University medical center and a tele-ICU with a full degree of treatment authority across the system.

摘要

背景

由于重症监护医师的短缺，提高重症监护服务的效率是必要的。规范临床实践、远程医疗和在卫生系统层面组织重症监护服务可以改善结果。我们在一家学术医疗中心建立了一个基于卫生系统的重症监护项目。该项目的主要特点是一名重症监护医师，他承担现场和远程医疗的临床责任。远程 ICU 有助于在整个系统内实现高质量的重症监护标准化。一个通用的电子病历使 ICU 之间的沟通成为可能。将内科和外科重症监护部门的教员结合起来，可以提高重症监护医师的工作效率。

研究设计

我们回顾性地审查了 2011 年和 2012 年的行政数据库数据，包括平均入住人数、转院人数、年龄、性别、病例组合指数、死亡率、再入院率和财务数据。

结果

重症监护项目有 106 张成人 ICU 床位；其中 54 张床位可以通过远程 ICU 进行远程管理，远程 ICU 设在主要的大学医院。2012 年系统午夜的平均入住人数为 69.44，总患者日数为 34406。远程 ICU 的资本成本为 1186220 美元。每年的运营成本为 1250112 美元，或每监测 ICU 床位 23150 美元。调整前死亡率为实施前的 6.5%和实施后的 4.9%（p<0.0002）。