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Table 2 Telemedicine intervention in the included studies

From: The effect of telemedicine in critically ill patients: systematic review and meta-analysis

Source

Study periods

Type of hospital/ICU

ICU staffing model

Type of interventiona

Intervention details

Intervention dose

Equipment

cointerventions

Rosenfeld et al. 2000 [10]

Pre 1: 1 Sept-18 Dec 1996

Pre 2: 1 Feb-18 May 1997b

Post: 1 Sept-18 Dec 1997

Academic-affiliated community hospital; surgical ICU

Open modelc

Low-intensity passive

Tele-intensivist interacted with patients and healthcare personnel via dedicated video conferencing and data transmission equipment 24 hours/day

Clinical and stored physiologic data reviewed q2hours

Formal video conferencing rounds occurred on 50% of days; otherwise, intensivist discussed each case with senior housestaff or attending physician

Tele-intensivists spent 4 to 5 hours/day on clinical care

Spacelabs Medical, Seattle WA

None

Breslow et al. 2004 [8]

Pre: 1 July 1999-20 June 2001

Post: 1 Jan-30 June 2001

Tertiary care, teaching; medical and surgical ICUs

Closed unit for teaching team of medical ICU patients (40%); open model for remaining medical ICU patients and surgical ICUc

High-intensity passive or active (alerts not clearly described)

Tele-ICU staff (board certified intensivist, nurse) monitored all patients 19 hours/day (1200-0700)

Admitting physician determined tele-ICU decision-making authority (all versus some versus off-hours)

Tele-ICU reviewed patient data q4hours

Not described

VISICU Inc. (eICU CARE), Baltimore MD

None

Marcin et al. 2004 [27]

Pre: Oct 1997-Sept 1998

Post: Apr 2000-Apr 2002d

Tertiary referral; adult ICU (with some pediatric patients)

Pediatric intensivist during baseline period only

Low-intensity passive

Consultation (at discretion of admitting physician) with tele-pediatric intensivist using portable telemedicine unit in pediatric ICU and five consultants' homes available 24 hours/day within 15 minutes

Number of consultations, one to seven per patient (median, 1; mean, 1.5)

Tandberg 800 video conference units

None

Kohl et al. 2007 [30]

Dates not reported

Academic; surgical ICU

Staffing model not described

High-intensity passive or active (based on vendor)

Tele-ICU staffed by board certified intensivists; no further details provided

Not described

VISICU Inc. (eICU CARE), Baltimore MD

None

Vespa et al. 2007 [28]

Pre: 2003-2004 fiscal year

Post: June 2005-June 2006

Academic; neurologic ICU

Staffing model not described; tele-intensivist same as on-site intensivist

Low-intensity passive

Robotic telepresence program for live interactive consultation and review of physiologic trends with intensivist [2000-0000 (weekdays); 1800 (weekends)]

Each patient reviewed for ≥ 5 minutes

Mean, two sessions/day

Mean night-time rounding session, 52 minutes

Robot: InTouch Health, Santa Barbara CA

Informatics system: Global Care Quest, Aliso Viejo CA

Integrated clinical information system

Paging protocol with goal of attending physician response within 15 minutes

Norman et al. 2009 [31]

Pre: Jan-Mar 2008

Post: Jan-Mar and Apr-June 2009e

Hospital not described; medical-surgical ICU

Staffing model not described

High-intensity passive or active (alerts not clearly described)

Tele-ICU staff ("team" included nurse; intensivist presence not specifically stated) reviewed patients; no further details provided

Not described

VISICU Inc. (eICU CARE), Baltimore MD

Electronic discharge management tool

Thomas et al. 2009 [9]

Pre: Jan 2003-Aug 2005

Post (staggered roll-out): July 2004-July 2006

Closedf medical and trauma/surgical ICU in tertiary care teaching hospital; two open medical-surgical ICUs in two small community hospitals; two open medical-surgical ICUs in two large urban hospitals

Active

Tele-ICU staffed by two physicians (noon -7 am Monday-Friday, 24 hours/day weekends), four registered nurses, and two administrative technicians

Rounds frequency: severely ill q1 hour, moderately ill q2 hours, relatively stable q4 hours

Local physicians delegated to tele-ICU authority for full treatment (31% of patients) or for intervention only for life-threatening events (66%)

Tele-ICU physicians gave 1,446 orders in 60 days (four ICUs)

Two closed ICUs, 5.3 orders/day (7% high-level interventions, (for example, code supervision, ventilator management)

Two open ICUs, 18.5 orders/day (26% high-level)

VISICU Inc. (eICU CARE), Baltimore MD

None

McCambridge et al. 2010 [11]

Pre: Sept 2002-Dec 2003

Post: Oct 2004-July 2005

Academic community hospital; three ICUs

Closed modelf

Active

Tele-ICU team (intensivist and critical care nurse) (1900-0700) admitted new patients and responded to phone calls from ICU nurses, computer-generated alerts, and radiographic abnormalities

Rounds for all monitored patients q2 hours

Not described

Vistacom Inc, Allentown PA

Health information technology bundle: EMR with automatic alerts (iMDsoft, Needham MA); CPOE, electronic MAR and bar-coded medication administration, PACS (GE Healthcare, Fairfield CT)

Morrison et al. 2010 [12]

Pre: Dec 2002-Mar 2003

Post 1: Dec 2004-Mar 2004

Post 2: July-Oct 2004g

One community teaching hospital (medical ICU, surgical ICU, cardiac ICU) and one community nonteaching hospital (medical-surgical ICU)

Open modelc

Active

Admitting physician responsible for care plan and determined involvement of tele-ICU (four categories from emergency care only to no restrictions)

Tele-intensivist reviewed all patient data at least q4 hours (q1 hour for sickest patients)

At teaching hospital, tele-intensivist supervised and taught housestaff "real-time"

Physician adoption of high-level (unrestricted) tele-ICU care differed (teaching hospital, 25% of physicians [post one], 57% [post two]; nonteaching hospital, 9% [post one], 27% [post two])

VISICU Inc. (eICU CARE), Baltimore MD, including "Sentry Alerts" software

Lilly et al. 2011 [29]

Pre: April 2005-Feb 2007

Post: (staggered roll-out) Aug 2006-Sept 2007

Academic medical center; seven ICUs: three medical, three surgical, and one mixed cardiovascular

Closed modelf

Active

Tele-ICU (hospital staff intensivist, affiliate

practitioner, systems analyst, ≥ one data clerks), 24 hours/day

Tele-ICU monitored 5-minute timed median vital sign values on electronic flow sheet; reviewed care; audited best-practice adherence real-time; reviewed night-time admissions; monitored electronic alerts, intervened when responses of bedside clinicians to in-room alarms delayed

Tele-ICU reviewed care plan for 48% of after-hours admissions (46% reviewed by other methods in pre period)

23 943 tele-ICU initiated interventions for physiologic instability that affected care plan (76% "major")

VISICU Inc. (eICU CARE), Baltimore MD;

APACHE (Cerner Healthcare Solutions, Kansas City MO)

Criticalware (UMass) software package to audit best practices (glycemic control; prevention of DVT, CRBSI, VAP)

None

Willmitch et al. 2012 [32]

Staggered roll-out: Dec 2005-July 2007

Pre: 1 year before roll-out

Post 1: year 1 after roll-out Post 2: year 2 after roll-out Post 3: year 3 after roll-outh

Five community hospitals with 10 ICUs

Closed modelf in largest hospital (28% of ICU beds in the study); otherwise open modelc

Active

Tele-ICU, staffed by one intensivist, three critical care nurses, and one secretary, 24 hours/day

All admitting and consulting physicians (n = 2,607) indicated level of tele-ICU intervention for their patients: 1% selected level I (emergency care only), 97% level II (best-practices adjustments), 2% level III (no restrictions)

Philips VISICU eCare Manager (Admission, discharge and transfer interfaces), Philips Smart Alerts, Philips VISICU camera system (Philips, Amsterdam, Netherlands)

None

  1. CPOE, computerized physician order entry; CRBSI, catheter-related bloodstream infection; DVT, deep vein thrombosis; EMR, electronic medical record; ICU, intensive care unit; MAR, medication administration record; PACS, picture archiving and communications system; VAP, ventilator-associated pneumonia. aActive system: continuous data monitoring with computer-generated alerts; high-intensity passive: continuous data monitoring without computer-generated alerts; low-intensity passive: no continuous data monitoring. bWe used data from both pre (baseline) periods. cOpen model refers to low-intensity on-site daytime intensivist staffing, in which patients may be cared for in the ICU without the mandatory involvement of an intensivist in their care. dPatients assigned to the control group in the meta-analysis include those from the baseline period and concurrent controls from the intervention period who did not receive a telemedicine consultation. ePatients in both intervention periods were included in the meta-analysis. fClosed model refers to high-intensity on-site daytime intensivist staffing, in which an intensivist must primarily manage or consult on all patients admitted to the ICU. gWe used data from both post (intervention) periods. hWe used data from all post (intervention) periods.