CHEST
Original Research: Critical CareICU Telemedicine Comanagement Methods and Length of Stay
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.