Washington University in St. Louis, St Louis, Missouri.
Medicine and Emergency and Operational Medicine, Uniformed Services University, Bethesda.
Curr Opin Crit Care. 2024 Jun 1;30(3):217-223. doi: 10.1097/MCC.0000000000001152. Epub 2024 Apr 12.
This article summarizes recent developments in the application of telemedicine, specifically tele-critical care (TCC), toward enhancing patient care during various types of emergencies and patient rescue scenarios when there are limited resources in terms of staff expertise (i.e., knowledge, skills, and abilities), staffing numbers, space, and supplies due to patient location (e.g., a non-ICU bed, the emergency department, a rural hospital) or patient volume as in pandemic surges.
The COVID-19 pandemic demonstrated the need for rapidly scalable and agile healthcare delivery systems. During the pandemic, clinicians and hospital systems adopted telemedicine for various applications. Taking advantage of technological improvements in cellular networks and personal mobile devices, and despite the limited outcomes literature to support its use, telemedicine was rapidly adopted to address the fundamental challenge of exposure in outpatient settings, emergency departments, patient follow-up, and home-based monitoring. A critical recognition was that the modality of care (e.g., remote vs. in-person) was less important than access to care, regardless of the patient outcomes. This fundamental shift, facilitated by policies that followed emergency declarations, provided an opportunity to maintain and, in many cases, expand and improve clinical practices and hospital systems by bringing expertise to the patient rather than the patient to the expertise. In addition to using telemedicine to maintain patient access to healthcare, TCC was harnessed to provide local clinicians, forced to manage critically ill patients beyond their normal scope of practice or experience, access to remote expertise (physician, nursing, respiratory therapist, pharmacist). These practices supported decades of literature from the telemedicine community describing the effectiveness of telemedicine in improving patient care and the many challenges defining its value.
In this review, we summarize numerous examples of innovative care delivery systems that have utilized telemedicine, focusing on 'mobile' TCC technology solutions to effectively deliver the best care to the patient regardless of patient location. We emphasize how a 'paradigm of better' can enhance the entirety of the healthcare system.
本文总结了远程医疗，特别是远程危重病护理（TCC）的最新应用进展，旨在提高各种类型紧急情况下的患者护理水平，并在因患者位置（例如，非 ICU 病床、急诊室、农村医院）或患者数量（如大流行期间）导致资源有限时，在人员专业知识（即知识、技能和能力）、人员数量、空间和供应方面，对患者进行救援。
COVID-19 大流行表明需要快速可扩展和灵活的医疗保健提供系统。大流行期间，临床医生和医院系统采用远程医疗进行各种应用。利用蜂窝网络和个人移动设备的技术改进，尽管支持其使用的结果文献有限，远程医疗还是迅速被采用，以解决门诊、急诊、患者随访和家庭监测环境中的暴露这一基本挑战。一个关键的认识是，护理方式（例如远程与面对面）不如获得护理重要，无论患者的结果如何。在随后的紧急声明政策的推动下，这种根本性转变提供了一个机会，可以在许多情况下维持、扩展和改进临床实践和医院系统，将专业知识带给患者，而不是让患者去找专业知识。除了使用远程医疗来维持患者获得医疗保健的机会外，还利用 TCC 为当地临床医生提供服务，这些临床医生被迫管理超出其正常实践或经验范围的危重病患者，为他们提供远程专业知识（医生、护士、呼吸治疗师、药剂师）。这些实践支持了远程医疗界数十年来描述远程医疗在改善患者护理方面的有效性以及定义其价值的许多挑战的文献。
在这篇综述中，我们总结了许多利用远程医疗的创新护理提供系统的例子，重点介绍了“移动”TCC 技术解决方案，以无论患者位置如何，为患者提供最佳护理。我们强调了“更好的典范”如何增强整个医疗保健系统。
