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Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

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.

Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, et al. Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes. JAMA [Internet]. 2011 May 16;Online first. Available from: http://jama.ama-assn.org/content/early/2011/05/12/jama.2011.697.abstract

17 May 2011

Bibliographic Data

Title:

Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes

Author(s):

Lilly, Craig M.; Cody, Shawn; Zhao, Huifang; Landry, Karen; Baker, Stephen P.; McIlwaine, John; Chandler, M. Willis; Irwin, Richard S.

Journal

JAMA, Online first
(2011-05-16)

URL:

Abstract

DOI:

10.1001/jama.2011.697

Keyword(s):

Hospitals, Tele-ICU, Telemedicine, United States

Citation:
Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, et al. Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes. JAMA [Internet]. 2011 May 16;Online first. Available from: http://jama.ama-assn.org/content/early/2011/05/12/jama.2011.697.abstract

Other Publications

In ICMCC Database

All JAMA articles (48).

Other article(s) by

Craig M. Lilly (3).

Discussion




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Miscellaneous

Affiliated University Institutes

University of Massachusetts - Memorial Medical Center - Department of Nursing, USA

University of Massachusetts - Memorial Medical Center - Graduate School of Biomedical Sciences, USA

University of Massachusetts - Medical School - Department of Medicine, USA

University of Massachusetts - Medical School - Department of Anesthesiology and Surgery, USA

University of Massachusetts - Memorial Medical Center - Clinical and Population Health Research Program, USA

University of Massachusetts - Memorial Health Care, USA

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PubMed

Craig M. Lilly
Stephen P. Baker
John McIlwaine
M. Willis Chandler
Richard S. Irwin
Karen Landry
Shawn Cody
Huifang Zhao

Google Scholar

Craig M. Lilly
Stephen P. Baker
John McIlwaine
M. Willis Chandler
Richard S. Irwin
Karen Landry
Shawn Cody
Huifang Zhao

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