Liron Sinvani is a researcher, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York; an associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and a geriatrician-hospitalist, Division of Geriatrics and Palliative Medicine and Division of Hospital Medicine, Department of Medicine, Northwell Health.
Craig Hertz is an assistant professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; a director, Tele-Intensive Care Unit (eICU), Division of TeleHealth, Northwell Health; and an intensivist, Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health.
Am J Crit Care. 2022 Jan 1;31(1):73-76. doi: 10.4037/ajcc2022773.
Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs.
This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses.
The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability.
Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the "unable to assess" designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P < .001). All 13 nurses strongly agreed that the training was beneficial and practice changing.
The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.
谵妄影响多达 80%的重症监护病房（ICU）患者，但多达 75%的病例被漏诊。ICU 的远程医疗（远程 ICU）已成为为远程 ICU 提供及时、专业护理的标准。
这项试点研究评估了使用远程 ICU 提高 ICU 护士进行谵妄筛查和识别准确性的可行性和可接受性。
试点地点包括 3 家医院的 4 个 ICU。一名具有谵妄专业知识的老年病学家通过远程 ICU 平台实时远程观察 13 名床边 ICU 护士对患者进行 ICU 意识模糊评估法（CAM-ICU），随后对 CAM-ICU 表现和谵妄管理进行培训。培训评估包括经过验证的抽查表、2 项满意度/实践改变调查，以及对可接受性的定性问题。
观察到 13 名 ICU 护士进行了 26 次床边谵妄评估。准确筛查谵妄的主要障碍是 CAM-ICU 知识不足、确定基线认知能力和不适当使用“无法评估”指定。正确观察的平均百分比从 40%（第一次观察）提高到 90%（第二次观察）（P <.001）。所有 13 名护士都强烈认为培训是有益的，且改变了实践。
使用远程 ICU 提高 ICU 护士对谵妄的筛查准确性，似乎可以有效地利用多个 ICU 的谵妄专业知识。未来的研究应评估远程 ICU 谵妄培训对以患者为中心的结果的影响。
