ICU 远程医疗共管方法和住院时间。

ICU Telemedicine Comanagement Methods and Length of Stay.

机构信息

School of Education, Colorado State University, Fort Collins, CO.

Departments of Medicine, Anesthesiology, and Surgery, University of Massachusetts Medical School, Worcester, MA; Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA.

出版信息

Chest. 2016 Aug;150(2):314-9. doi: 10.1016/j.chest.2016.03.030. Epub 2016 Apr 3.

DOI:10.1016/j.chest.2016.03.030

PMID:27048869

Abstract

BACKGROUND

Studies have identified processes that are associated with more favorable length of stay (LOS) outcomes when an ICU telemedicine program is implemented. Despite these studies, the relation of the acceptance of ICU telemedicine management services by individual ICUs to LOS outcomes is unknown.

METHODS

This is a single ICU telemedicine center study that compares LOS outcomes among three groups of intensivist-staffed mixed medical-surgical ICUs that used alternative comanagement strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders was compared among ICUs that used a monitor and notify comanagement approach, a direct intervention with timely notification process, and ICUs that used a mix of these two approaches. The primary outcome was acuity-adjusted hospital LOS.

RESULTS

ICUs that used the direct intervention with timely notification strategy had a significantly larger proportion of provider orders recorded by ICU telemedicine physicians than the mixed methods of comanagement group, which had a larger proportion than ICUs that used the monitor and notify method (P < .001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification comanagement strategy (0.68; 0.65-0.70) compared with the mixed methods group (0.70 [0.69-0.72]; P = .01), which was significantly lower than the monitor and notify group (0.83 [0.80-0.86]; P < .001).

CONCLUSIONS

Direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter LOS outcomes than monitor and notify comanagement strategies.

摘要

背景

已有研究确定了 ICU 远程医疗项目实施时与更有利的住院时间（LOS）结果相关的流程。尽管有这些研究，但 ICU 对 ICU 远程医疗管理服务的接受程度与 LOS 结果的关系尚不清楚。

方法

这是一项单 ICU 远程医疗中心研究，比较了使用替代共管策略的 3 组由重症监护医生人员配备的混合内科-外科 ICU 的 LOS 结果。比较了使用监视器和通知共管方法、具有及时通知流程的直接干预以及同时使用这两种方法的 ICU 中，由 ICU 远程医疗提供者记录的提供者医嘱与所有记录的医嘱的比例。主要结果是调整后的医院 LOS。

结果

使用直接干预和及时通知策略的 ICU 中，由 ICU 远程医疗医生记录的提供者医嘱比例明显大于混合共管组，而混合共管组的比例大于使用监视器和通知方法的 ICU（P<.001）。与混合方法组（0.70 [0.69-0.72]；P=.01）相比，直接干预和及时通知共管策略的调整后医院 LOS 明显更低（0.68 [0.65-0.70]），而与监视器和通知组相比（0.83 [0.80-0.86]；P<.001）。