CHEST
Volume 150, Issue 2, August 2016, Pages 314-319
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Original Research: Critical Care
ICU Telemedicine Comanagement Methods and Length of Stay

https://doi.org/10.1016/j.chest.2016.03.030Get rights and content

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.

Section snippets

Methods

This study was a retrospective, comparative, quantitative analysis of patient-level data that included all adult patients discharged from eight participating adult medical-surgical ICUs from a single US health-care system during calendar year 2012. Institutional review board approval was obtained internally from the health-care system. Each participating ICU was classified into one of three ICU telemedicine comanagement groups based on its predominant comanagement strategy. One group used the

Results

Characteristics of the patients of the ICU telemedicine comanagement groups are presented in Table 1. The ratios of provider orders recorded by the ICU telemedicine physician per patient stay and the ratio of ICU telemedicine to all provider orders were significantly different among the direct intervention with timely communication, mixed comanagement, and monitor and notify groups (Table 2). The direct intervention with timely communication group had significantly higher ratios of ICU

Discussion

The main finding of this study of the effects of alternative ICU telemedicine comanagement strategies on LOS outcomes is that methods that encourage direct comanagement were associated with significantly shorter ICU and hospital LOS than a monitor and notify approach that discouraged direct intervention. The magnitude of the differences in hospital LOS among the direct intervention with timely communication, mixed model, and monitor and notify groups is large enough to be clinically significant

Acknowledgments

Author contributions: H. K., the corresponding author, is the guarantor of the content of this manuscript. H. A. H., with continual assistance, support, and input from H. K. and R. H. G., contributed to all aspects of the study including planning, institutional review board submission, study design, data collection and analysis, literature review, and initial writing of the manuscript. C. M. L. was a major contributor to data analysis and the writing of the final manuscript. D. A. K. was a

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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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