Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, 1127 E James E. Rogers Way, Tucson, AZ 85721-0020. Email:
Am J Manag Care. 2023 Jul 1;29(7):e208-e214. doi: 10.37765/ajmc.2023.89400.
Tele-intensive care unit (tele-ICU) use has become increasingly common as an extension of bedside care for critically ill patients. The objective of this work was to illustrate the degree of tele-ICU involvement in critical care processes and evaluate the impact of tele-ICU decision-making authority.
Previous studies examining tele-ICU impact on patient outcomes do not sufficiently account for the extent of decision-making authority between remote and bedside providers. In this study, we examine patient outcomes with respect to different levels of remote intervention.
Analysis and summary statistics were generated to characterize demographics and patient outcomes across different levels of tele-ICU intervention for 82,049 critically ill patients. Multivariate logistic regression was used to evaluate odds of mortality, readmission, and likelihood of patients being assigned to a particular remote intervention category.
Managing (vs consulting) physician type influenced the level of remote intervention (adjusted odds ratio [AOR], 2.42). A higher level of tele-ICU intervention was a significant factor for patient mortality (AOR, 1.25). Female sex (AOR, 1.05), illness severity (AOR, 1.01), and higher tele-ICU intervention level (AOR, 1.13) increased odds of ICU readmission, whereas length of stay in number of days (AOR, 0.93) and consulting (vs managing) physician type (AOR, 0.79) decreased readmission odds.
This study's findings suggest that higher levels of tele-ICU intervention do not negatively affect patient outcomes. Our results are a step toward understanding tele-ICU impact on patient outcomes by accounting for extent of decision-making authority, and they suggest that the level of remote intervention may reflect patient severity. Further research using more granular data is needed to better understand assignment of intervention category and how variable levels of authority affect clinical decision-making in tele-ICU settings.
作为对危重病患者床边护理的延伸，远程重症监护病房（Tele-ICU）的使用越来越普遍。本研究旨在说明 Tele-ICU 在重症监护过程中的参与程度，并评估 Tele-ICU 决策权限的影响。
之前研究 Tele-ICU 对患者结局影响的研究没有充分考虑远程和床边提供者之间的决策权限程度。在这项研究中，我们根据远程干预的不同程度来检查患者的结局。
对 82049 名危重病患者的不同 Tele-ICU 干预水平的人口统计学和患者结局进行了分析和总结统计。使用多变量逻辑回归来评估死亡率、再入院率以及患者被分配到特定远程干预类别的可能性。
管理（vs 咨询）医生类型影响远程干预水平（调整后的优势比[OR]，2.42）。更高水平的 Tele-ICU 干预是患者死亡的一个显著因素（OR，1.25）。女性（OR，1.05）、疾病严重程度（OR，1.01）和更高的 Tele-ICU 干预水平（OR，1.13）增加了 ICU 再入院的几率，而住院时间的长短（OR，0.93）和咨询（vs 管理）医生类型（OR，0.79）降低了再入院的几率。
本研究的结果表明，更高水平的 Tele-ICU 干预不会对患者结局产生负面影响。我们的结果是朝着理解 Tele-ICU 对患者结局的影响迈出的一步，考虑到决策权限的程度，这表明远程干预的水平可能反映了患者的严重程度。需要使用更详细的数据进行进一步研究，以更好地理解干预类别的分配以及不同权限水平如何影响 Tele-ICU 环境中的临床决策。
