SESSION TYPE: Improving Processes and Outcomes in Adult Critical Care
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: The variable impact of TeleICU practice on ventilator management may reflect structural and process differences among TeleICU providers. In this study, we asked if the implementation of daily scheduled ventilator rounds via TeleICU platform enhanced process efficiency and outcome.
METHODS: A retrospective, population-based, cross-sectional analysis was conducted comparing APACHE IV adjusted Ventilation Duration Ratio [VDR] and low Vt strategy adherence [for P/F<300] before and after implementation of TeleICU directed daily bedside ventilator rounds. The study was conducted by an independent TeleICU practice utilizing Philips VISICU™ licensed eCare Manager™ platform, providing ICU care and process improvement programs to community hospital ICUs with wide geographic distribution. Hospitals were included that subscribed to TeleICU services during both pre-and post-ventilator rounds implementation. Multidisciplinary ventilator rounds required participation of TeleICU physicians utilizing audiovisual link to bedside respiratory therapist and nurse. Ventilator settings, CXR review, and liberation readiness evaluation were facilitated by template checklist prepopulated by TeleICU nurse and nurse practitioner. One subscribing hospital included in cross-sectional analysis [Hospital 2] did not adopt structured ventilator rounds,though they received quarterly data and feedback on performance during the follow-up interval.
RESULTS: Significant reduction was noted in mean VDR after implementation of TeleICU conducted ventilator rounds [1.04±0.27 v. 0.72±0.24, p<0.01, pre-implementation (Q4/2009; n=385) v. post implementation (Q3/2011; n=295)]. In patients with P/F<300, percentage Vt < 7.5ml/kg IBW improved from 42.6 to 47.5% [p<0.01; n=1416]. In the subset of patients with documented ARDS/ALI, Vt < 6.5 ml/kg IBW improved from 23.3 to 55% [p<0.001; n=129]. Exposure to formal daily ventilator rounds was associated with improved Vt adherence [Hospitals 1, 3, & 4; p<0.02], whereas the absence of this exposure was associated with no improvement.
CONCLUSIONS: The association of improved ventilator duration ratio and low Vt strategy after TeleICU participation in structured daily ventilator rounds raises the possibility that this process contributed to the observed improvements.
CLINICAL IMPLICATIONS: TeleICU process improvement initiatives may impact upon important efficiency and outcome measures regarding ventilator management.
DISCLOSURE: Thomas Kalb: Employee: Advanced ICU Care associate medical director
Corey Scurlock: Employee: Medical Director, Advanced ICU Care
Molly Lane: Employee: Employed by Advanced ICU Care
Erica Uhrhan: Employee: Employed by Advanced ICU Care
Francis Ntimba: Employee: Employed by Advanced ICU Care
Shelley Meyer: Employee: Employed by Advanced ICU Care
Mary Jo Gorman: Employee: CEO, Advanced ICU care
Isabelle Kopec: Employee: VPMA, Advanced ICU Care
No Product/Research Disclosure InformationHofstra North Shore-LIJ School of Medicine, Hempstead, NY