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Article
Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes
GSBS Student Publications
  • Craig M. Lilly, University of Massachusetts Medical School
  • Shawn Cody, UMass Memorial Health Care
  • Huifang Zhao, University of Massachusetts Medical School
  • Karen Landry, UMass Memorial Health Care
  • Stephen P. Baker, University of Massachusetts Medical School
  • John McIlwaine, University of Massachusetts Medical School
  • M. Willis Chandler, UMass Memorial Health Care
  • Richard S. Irwin, University of Massachusetts Medical School
  • Stephen O. Heard, University of Massachusetts Medical School
  • J. Matthias Walz, University of Massachusetts Medical School
  • Khaldoun Faris, University of Massachusetts Medical School
Student Author(s)
Huifang Zhao
UMMS Affiliation
Department of Medicine; Information Services; Department of Cell Biology; Department of Quantitative Health Sciences; Department of Anesthesiology
Date
6-1-2011
Document Type
Article
Medical Subject Headings
Academic Medical Centers; Critical Care; Telemedicine; Intensive Care; Intensive Care Units; Outcome and Process Assessment (Health Care); Hospital Mortality; Length of Stay
Abstract
Context: The association of an adult tele-intensive care unit (ICU) intervention with hospital mortality, length of stay, best practice adherence, and preventable complications for an academic medical center has not been reported. Objective: To quantify the association of a tele-ICU intervention with hospital mortality, length of stay, and complications that are preventable by adherence to best practices. Design, Setting, and Patients: Prospective stepped-wedge clinical practice study of 6290 adults admitted to any of 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on 2 campuses of an 834-bed academic medical center that was performed from April 26, 2005, through September 30, 2007. Electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms were evaluated. Main Outcome Measures: Case-mix and severity-adjusted hospital mortality. Other outcomes included hospital and ICU length of stay, best practice adherence, and complication rates. Results: The hospital mortality rate was 13.6% (95% confidence interval [CI], 11.9%-15.4%) during the preintervention period compared with 11.8% (95% CI, 10.9%-12.8%) during the tele-ICU intervention period (adjusted odds ratio [OR], 0.40 [95% CI, 0.31-0.52]). The tele-ICU intervention period compared with the preintervention period was associated with higher rates of best clinical practice adherence for the prevention of deep vein thrombosis (99% vs 85%, respectively; OR, 15.4 [95% CI, 11.3-21.1]) and prevention of stress ulcers (96% vs 83%, respectively; OR, 4.57 [95% CI, 3.91-5.77], best practice adherence for cardiovascular protection (99% vs 80%, respectively; OR, 30.7 [95% CI, 19.3-49.2]), prevention of ventilator-associated pneumonia (52% vs 33%, respectively; OR, 2.20 [95% CI, 1.79-2.70]), lower rates of preventable complications (1.6% vs 13%, respectively, for ventilator-associated pneumonia [OR, 0.15; 95% CI, 0.09-0.23] and 0.6% vs 1.0%, respectively, for catheter-related bloodstream infection [OR, 0.50; 95% CI, 0.27-0.93]), and shorter hospital length of stay (9.8 vs 13.3 days, respectively; hazard ratio for discharge, 1.44 [95% CI, 1.33-1.56]). The results for medical, surgical, and cardiovascular ICUs were similar. Conclusion: 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.
Comments

Citation: JAMA. 2011 Jun 1;305(21):2175-83. Epub 2011 May 16. DOI 10.1001/jama.2011.697

University of Massachusetts Memorial Critical Care Operations Group: Nicholas A. Smyrnios, MD, Stephen O. Heard, MD, Nicholas Hemeon, Timothy A. Emhoff, MD, Peter H. Bagley, MD, Sara E. Cody, Michael J. Davis, Cheryl Lopriore, Greg Wongkam, Diane Henry, J. Matthias Walz, MD, Margaret Naughton, BSN, RN, Michelle M. Fernald, MS, RN, Debra Lynn Svec, RN, Karen Ostiguy, MSN, Nam Heui Kim, MD, Cheryl H. Dunnington, MS, RN, Nancy Simon, MS, RN, M. Elizabeth Colo, MS, RN, Bruce J. Simon, MD, Karen Shea, MS, RN, Wiley R. Hall, MD, Robert Spicer, RN, Lynn Harrison, MD, Naomi F. Botkin, MD, Craig Smith, MD, Gail Frigoletto, BSN, RN, Melinda Darrigo, MS, NP, Cathy Pianka, MS, RN, Linda Josephson, MS, RN, Khaldoun Faris, MD, Scott E. Kopec, MD, Scott Leonard, MBA, RRT, Cynthia T. French, MS, ANP-BC, Helen M. Flaherty, MS, RN, Sara Fine, and Walter H. Ettinger Jr.

Related Resources
Link to article in PubMed
PubMed ID
21576622
Citation Information
Craig M. Lilly, Shawn Cody, Huifang Zhao, Karen Landry, et al.. "Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes" (2011) ISSN: 1538-3598
Available at: http://works.bepress.com/stephen_baker/98/