ICU Telemedicine Co-Management Methods and Length of Stay.
Chest. 2016 Apr 2;
Authors: Hawkins HA, Lilly CM, Kaster DA, Groves RH, Khurana H
BACKGROUND: Recent studies have identified processes that are associated with more favorable length of stay 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 length of stay (LOS) outcomes is unknown.
METHODS: This is a single ICU telemedicine center study that compares length of stay outcomes among 3 groups of intensivist staffed mixed medical surgical ICUs that used alternative co-management strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders were compared among ICUs that used a monitor and notify co-management 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 length of stay.
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 co-management group, which had a larger proportion than ICUs that used the monitor and notify method (p < 0.001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification co-management strategy 0.68 (.65 to .70) compared to the mixed methods group (0.70 (.69 to .72); p =0.01), which was significantly lower than the monitor and notify group (0.83 (.80 to .86); p< 0.001).
CONCLUSIONS: Direct intervention with timely notification strategies of ICU telemedicine co-management were associated with shorter LOS outcomes than monitor and notify co-management strategies.
PMID: 27048869 [PubMed - as supplied by publisher]