Laudanski Krzysztof, Scruth Elizabeth, Winterbottom Fiona, Rastrepo Mariana, Dugar Siddharth, Herasevich Vitaly, Villanueva Israel, Armaignac Donna Lee, Scott Benjamin K
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA.
Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
Healthcare (Basel). 2022 Aug 1;10(8):1445. doi: 10.3390/healthcare10081445.
The study's objective was to assess facilitators and barriers of Tele-Critical Care (TCC) perceived by SCCM members. By utilizing a survey distributed to SCCM members, a cross-sectional study was developed to analyze survey results from December 2019 and July 2020. SCCM members responded to the survey ( = 15,502) with a 1.9% response rate for the first distribution and a 2.54% response rate for the second survey ( = 9985). Participants ( = 286 and = 254) were almost equally distributed between non-users, providers, users, and potential users of TCC services. The care delivery models for TCC were similar across most participants. Some consumers of TCC services preferred algorithmic coverage and scheduled rounds, while reactive and on-demand models were less utilized. The surveys revealed that outcome-driven measures were the principal form of TCC performance evaluation. A 1:100 (provider: patients) ratio was reported to be optimal. Factors related to costs, perceived lack of need for services, and workflow challenges were described by those who terminated TCC services. Barriers to implementation revolved around lack of reimbursement and adequate training. Interpersonal communication was identified as an essential TCC provider skill. The second survey introduced after the onset pandemic demonstrated more frequent use of advanced practice providers and focus on performance measures. Priorities for effective TCC deployment include communication, knowledge, optimal operationalization, and outcomes measurement at the organizational level. The potential effect of COVID-19 during the early stages of the pandemic on survey responses was limited and focused on the need to demonstrate TCC value.
该研究的目的是评估危重病医学会(SCCM)成员所感知到的远程重症监护(TCC)的促进因素和障碍。通过向SCCM成员发放调查问卷,开展了一项横断面研究,以分析2019年12月至2020年7月的调查结果。SCCM成员对调查进行了回复(n = 15,502),首次发放的回复率为1.9%,第二次调查的回复率为2.54%(n = 9985)。参与者(n = 286和n = 254)在TCC服务的非使用者、提供者、使用者和潜在使用者之间的分布几乎相等。大多数参与者的TCC护理提供模式相似。一些TCC服务消费者更喜欢算法覆盖和定期查房,而反应性和按需模式的使用较少。调查显示,结果驱动的措施是TCC绩效评估的主要形式。据报告,1:100(提供者:患者)的比例是最佳的。终止TCC服务的人描述了与成本、认为缺乏服务需求以及工作流程挑战相关的因素。实施障碍主要围绕报销不足和培训不足。人际沟通被确定为TCC提供者的一项基本技能。疫情爆发后进行的第二次调查表明,高级实践提供者的使用更为频繁,且更注重绩效指标。有效部署TCC的优先事项包括组织层面的沟通、知识、最佳运营以及结果测量。疫情早期阶段COVID-19对调查回复的潜在影响有限,且主要集中在证明TCC价值的必要性上。