Standardizing Sepsis Screening and Management via a Tele-ICU Program Improves Patient Care

Rincon, Teresa; Bourke, Grace; Seiver, Adam

doi:10.1089/tmj.2010.0225

Cited by 30 publications

(16 citation statements)

References 25 publications

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“…In particular, telemedicine services have been utilized in the ICU setting to assist with the screening and management of patients with severe sepsis. 7 Severe sepsis remains a major health problem, with significant morbidity and mortality rates approaching 50%. 8 In the United States, there are an estimated 750,000 to 1.2 million cases of sepsis with a mortality rate of 215,000 deaths annually.…”

Section: Introductionmentioning

confidence: 99%

“…11 However, there are projected future shortages of both critical care nursing staff and available intensivists by 2020. 7,12 In 2011, Rincon and colleagues evaluated the implementation of telemedicine care across a large hospital system in Northern California. 7 A tele-ICU team of critical care doctors and nurses based at two separate remote sites utilized a 'checklist to care' for all patients admitted to the intensive care units (ICUs) at 10 different hospitals.…”

Section: Introductionmentioning

confidence: 99%

“…7,12 In 2011, Rincon and colleagues evaluated the implementation of telemedicine care across a large hospital system in Northern California. 7 A tele-ICU team of critical care doctors and nurses based at two separate remote sites utilized a 'checklist to care' for all patients admitted to the intensive care units (ICUs) at 10 different hospitals. These authors demonstrated earlier identification and improved compliance with evidence-based practice bundles for severe sepsis following the implementation of telemedicine sepsis care into the ICU setting.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department

et al. 2017

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Introduction Intensivist involvement for patients with sepsis is associated with decreased complications and mortality, and lower hospital resource utilization, but few studies have evaluated outcomes for patients exposed to electronic intensive care unit (eICU) telemedicine sepsis management in the emergency department (ED). In this study, we assess whether eICU cart exposure in the ED improved compliance with components of the 2010 Surviving Sepsis Campaign bundles, length of stay (LOS), disposition and hospital costs. Methods An institutional review board-approved, retrospective cohort study was completed on patients with confirmed sepsis who presented to our ED from July 2010 through February 2013. Results Of 711 patient ED encounters, 314 cases met criteria for analysis (95 exposed and 219 non-exposed). Patient cohorts had similar demographics and comorbid International Classification of Diseases, Ninth Edition (ICD-9) diagnoses. The exposed cohort received antibiotics more quickly (122.3 minutes ±83.3 versus 163.4 minutes ±204.4, p = 0.043) and were more likely to have lactic acid levels drawn within six hours (98.9% vs. 90%, p = 0.019). The exposed cohort had a shortened ED LOS (in days) 0.08 ± 0.28 versus 0.16 ± 0.37, p = 0.036. Hospital LOS, disposition and death were similar in both cohorts. Total hospital costs for the exposed cohort were lower and less variable (US$19,713 ± 16,550 vs. US$24,364 ± 25068), but this was not significant ( p = 0.274). Discussion Our findings suggest that in individuals with confirmed sepsis, ED exposure to a telemedicine-based eICU cart impacted adherence to aspects of the Surviving Sepsis Campaign recommended bundle, but did not impact overall survival and medical costs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department

et al. 2017

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“…Technology, such as telemedicine may play a significant role reducing the need for specialized staff [14]. Other measures, such as the use of remote application of checklists, are associated with improved adherence to best practices [15].…”

Section: Technological Challengesmentioning

confidence: 99%

Intensive Care Medicine in 2050: global perspectives

2016

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The changing world With a projected increase in the world population from 7.2 billion currently to 9.6 billion by 2050, the population of the 49 least developed countries is expected to double from 900 million in 2013 to 1.8 billion [1]. As such, the number of patients who may need critical care will increase substantially, with a majority of these in resource-restricted settings. Coupled with an ageing global population, the complexity of the challenge will be enormous. Infectious diseases and trauma will continue to be main reasons for intensive care unit (ICU) admission, but natural as well as man-made disasters will occasionally place additional strain on critical care services, with the largest strain again in resourcerestricted settings. Healthcare expenditures vary considerably from approximately US $9400 annually per capita in the USA to less than US $20 per capita in many African countries [2], and with limited financial resources, the strategic priority is given to public health programs and not to more expensive services such as critical care. Around the globe, what constitutes an ICU will continue to vary in terms of structure, processes and staffing, all of which often remain inadequate in resource-restricted settings [3]. However, the basic premise will remain the same: the outcome of critically ill patients will substantially be improved by the provision of essential critical care [4], and many aspects can and should be provided even if resources are low [5]. Moving towards better critical care globally will require a multifaceted approach to address not only patient and organizational challenges, but also those related to staffing, cultural and technological aspects, as well as quality and safety. Addressing these complex challenges will certainly require involvement not only at the local ICU level but also at the level of hospitals, national societies and governments. In Table 1, we present examples of where and how critical care could and should improve, with a focus on resource-restricted settings. Some of these cases are highlighted in the following text.

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“…20 Improved patient safety and care were found with tele-ICU utilization. 35 Adherence to best practices and decrease of medication errors with tele-ICU utilization 27,51,53 Patient and provider satisfaction Tele-ICU technology has been shown to improve patient and provider satisfaction. 36,54 Barriers Organizational challenges Tele-ICU implementation requires significant changes to the organizational culture that are challenges for implementation.…”

Section: Utilization Of Telemedicine Technology In the Icumentioning

confidence: 99%

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine

Deslich

Coustasse²

2014

Telemedicine and e-Health

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Standardizing Sepsis Screening and Management via a Tele-ICU Program Improves Patient Care

Abstract: A tele-ICU nurse-driven process can prompt earlier identification and improve compliance to evidence-based practice bundles for complex disease states such as severe sepsis.

Cited by 30 publications

References 25 publications

Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department

Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department

Intensive Care Medicine in 2050: global perspectives

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine

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