Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

Lilly, Craig M.; Cody, Shawn; Zhao, Hong; Landry, Karen; Baker, Stephen P.; McIlwaine, John; Chandler, Marni; Irwin, Richard S.

doi:10.1001/jama.2011.697

Cited by 419 publications

(285 citation statements)

References 37 publications

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“…Moreover, many authors have reported that patients enrolled in telemedicineenabled ICU programs experience improved clinical outcomes, reductions in complications, and improved evidence-based bundle compliance compared with those not enrolled in programs. [15][16][17][18] Our study has several limitations. First, we did not randomize the children to receive Family-Link, and therefore the potential confounding biases may exist.…”

Section: Discussionmentioning

confidence: 95%

Videoconferencing to Reduce Stress Among Hospitalized Children

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.WHAT THIS STUDY ADDS: Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing.abstract OBJECTIVES: Family-Link is a videoconferencing program that allows hospitalized children and their parents to virtually visit family members and friends using laptops, webcams, and a secure Wi-Fi connection. We evaluated the association of Family-Link use on the reduction in stress experienced by children during hospitalization. METHODS:We offered Family-Link to pediatric patients who had an expected length of hospitalization equal to or greater than 4 days. We measured the stress levels of hospitalized children at admission and discharge using the previously published Parental Stress Survey. We used propensity score matching and multivariable linear regression methods to evaluate the relationship between the use of Family-Link and stress experienced by children during hospitalization. RESULTS:We included a total of 367 children in the study: 232 FamilyLink users and 135 non-Family-Link users. Using the propensity score matching method, we found that the use of Family-Link was significantly associated with a greater reduction in overall mean stress compared with non-Family-Link users among the cohort of patients who lived closer to the hospital and had shorter lengths of hospitalization (b = 0.23; 95% confidence interval, 0.03 to 0.43; P , .05). In this cohort, the reduction in overall mean stress was 37% greater among Family-Link users than non-Family-Link users. CONCLUSIONS:The use of videoconferencing by some hospitalized children and families to conduct virtual visits with family and friends outside of the hospital was associated with a greater reduction in stress during hospitalization than those who did not use videoconferencing. Dr Yang conceptualized and designed the study, coordinated the data collection process, completed the analyses, interpreted the results, and drafted the initial manuscript; Dr Dharmar conceptualized and designed the study, coordinated the data collection process, assisted with the analyses, interpreted the results, and revised the manuscript; Ms Hojman assisted with the data collection process, assisted with the analyses, and critically reviewed the manuscript; Ms Sadorra coordinated the data collection process, assisted with the analyses, and critically reviewed the manuscript; Ms Sundberg coordinated the data collection process and critically reviewed the manuscript; Mr Wold assisted with the data collection process and critically reviewed t...

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Section: Discussionmentioning

confidence: 95%

Videoconferencing to Reduce Stress Among Hospitalized Children

et al. 2014

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“…[9][10][11] To improve the quality of critical care and extend the reach of the current intensivist workforce, at least 40 health-care systems in the United States have implemented telemedicine programs in ICUs (tele-ICUs). [12][13][14][15] Tele-ICUs typically combine real-time videoconferencing, telemetry, and electronic health records (EHRs). A tele-ICU allows physician and nurse intensivists located in a centralized monitoring center to monitor and care for patients in multiple distant ICUs.…”

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confidence: 99%

The Costs of Critical Care Telemedicine Programs

Kumar

Falk

Bonello

et al. 2013

Chest

111

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ICUs deliver focused care to critically ill patients; but despite advances in ICU care, mortality rates remain high and vary significantly. 1,2 There is an increased effort to improve patient outcomes by providing dedicated intensivist staffi ng in all ICUs and promoting adoption of evidence-based therapies. [3][4][5][6][7][8] Access to intensivists has been hampered by an array of factors, most notably the limited supply of intensivists, particularly for smaller hospitals and rural geographic regions. [9][10][11] To improve the quality of critical care and extend the reach of the current intensivist workforce, at least 40 health-care systems in the United States have implemented telemedicine programs in ICUs (tele-ICUs). [12][13][14][15] Tele-ICUs typically combine real-time videoconferencing, telemetry, and electronic health records (EHRs). A tele-ICU allows physician and nurse intensivists located in a centralized monitoring center to monitor and care for patients in multiple distant ICUs. 16,17 Although the tele-ICU concept may be similar across facilities, the technology and associated treatment protocols (eg, ventilator protocols, sepsis management, best practice protocols) can vary signifi cantly across Background: Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. Methods: We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Results: Our systematic review identifi ed eight studies reporting tele-ICU costs. These studies suggested combined implementation and fi rst year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and fi rst year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. Conclusions:The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profi ts is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.

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“…Care at hospitals with low annual sepsis case volumes is associated with increased mortality, whereas care at hospitals with intermediate annual case volumes is not associated with worse mortality compared with hospitals with high annual case volumes. Future efforts toward the dissemination of best practices to LV hospitals (19), ICU outreach programs using telehealth technology (57), and/or regionalization of sepsis care (21,22,58) may all be important strategies to eliminate existing disparities. Important barriers exist, which could limit the effectiveness of each strategy, and, at this time, the optimal approach is not known.…”

Section: Resultsmentioning

confidence: 99%

Volume-Mortality Relationships during Hospitalization with Severe Sepsis Exist Only at Low Case Volumes

Goodwin¹,

Simpson

Ford³

2015

Annals ATS

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Rationale: Volume-outcome associations have been demonstrated in conditions with high morbidity and mortality; however, the existing literature regarding such associations in sepsis is not definitive.Objectives: To test the hypothesis that annual hospital severe sepsis case volume is associated with mortality during admissions with severe sepsis in teaching and nonteaching hospitals.Methods: This work was a retrospective cohort study of administrative data from the South Carolina State Inpatient Database using multivariate logistic regression and case mix adjustment. Measurements and Main Results:In the calendar year 2010, 9,815 patients were admitted with severe sepsis or septic shock. Hospitals were stratified into low-(0-75 cases/yr, n = 26), intermediate-(76-300 cases/yr, n = 19), and high (.300 cases/yr, n = 12) -volume tertiles. Patients admitted to hospitals with a low annual case volume for sepsis had higher adjusted odds of dying before discharge (odds ratio, 1.56; 95% confidence interval, 1.25-1.94) compared with patients admitted to high-volume hospitals. Hospitalization at intermediate-volume hospitals was not associated with a difference in mortality (odds ratio, 0.99; 95% confidence interval, 0.90-1.09) compared with high-volume hospitals. There was no difference between the mortality rates of intermediate-and highvolume hospitals at different severity of illness quartiles. Hospital length of stay differed significantly by hospital case volume (low = 8.0, intermediate = 12.7, high = 14.9 [d]; P , 0.0001).Conclusions: Hospitals with low annual sepsis case volume are associated with higher mortality rates, whereas hospitals with intermediate sepsis case volumes are associated with similar mortality rates compared with hospitals with high case volumes.

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Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

Abstract: In a single academic medical center study, implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with changes in best practice adherence and lower rates of preventable complications.

Cited by 419 publications

References 37 publications

Videoconferencing to Reduce Stress Among Hospitalized Children

Videoconferencing to Reduce Stress Among Hospitalized Children

The Costs of Critical Care Telemedicine Programs

Volume-Mortality Relationships during Hospitalization with Severe Sepsis Exist Only at Low Case Volumes

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