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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

Study periods
Type of hospital/ICU
ICU staffing model
Type of interventiona
Intervention details Intervention dose Equipment
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
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
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
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
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
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
McCambridge et al. 2010 [11]
Pre: Sept 2002-Dec 2003
Post: Oct 2004-July 2005
Academic community hospital; three ICUs
Closed modelf
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
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
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)
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
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)
  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.