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Original Research: Critical Care |

ICU Telemedicine Comanagement Methods and Length of Stay

Helen A. Hawkins, PhD; Craig M. Lilly, MD, FCCP; David A. Kaster, BS; Robert H. Groves, Jr., MD, FCCP; Hargobind Khurana, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aSchool of Education, Colorado State University, Fort Collins, CO

bDepartments of Medicine, Anesthesiology, and Surgery, University of Massachusetts Medical School, Worcester, MA

cClinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA

dGraduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA

eHealth Management, Banner Health, Phoenix, AZ

fBanner-University Medicine Division, Banner Health, Phoenix, AZ

CORRESPONDENCE TO: Hargobind Khurana, MD, Health Management, Banner Health, 1441 N 12th St, Phoenix, AZ 85006


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):314-319. doi:10.1016/j.chest.2016.03.030
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Published online

Background  Studies have identified processes that are associated with more favorable length of stay (LOS) 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 LOS outcomes is unknown.

Methods  This is a single ICU telemedicine center study that compares LOS outcomes among three groups of intensivist-staffed mixed medical-surgical ICUs that used alternative comanagement strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders was compared among ICUs that used a monitor and notify comanagement 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 LOS.

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 comanagement group, which had a larger proportion than ICUs that used the monitor and notify method (P < .001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification comanagement strategy (0.68; 0.65-0.70) compared with the mixed methods group (0.70 [0.69-0.72]; P = .01), which was significantly lower than the monitor and notify group (0.83 [0.80-0.86]; P < .001).

Conclusions  Direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter LOS outcomes than monitor and notify comanagement strategies.

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