The Research Agenda in ICU Telemedicine A Statement From the Critical Care Societies Collaborative
ABSTRACT ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care.
Full-textDOI: · Available from: Judith Jacobi, Jun 09, 2015
- Critical Care Medicine 11/2014; 42(11):2457-8. DOI:10.1097/CCM.0000000000000596 · 6.15 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Hemodynamic instability and shock are important causes of mortality worldwide. Improving outcomes for these patients through effective resuscitation is a key priority for the health system. This article discusses several organizational approaches to improving resuscitation effectiveness and outlines key areas for future research and development. The discussion is rooted in a conceptual model of effective resuscitation based on three domains: monitoring systems, response teams, and feedback mechanisms. Targeting each of these domains in a unified approach helps clinicians effectively treat deteriorating patients, ultimately improving outcomes for this high-risk patient group. Copyright © 2015 Elsevier Inc. All rights reserved.Critical Care Clinics 01/2014; 31(1). DOI:10.1016/j.ccc.2014.08.008 · 2.50 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use. Materials and Methods: We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States. Results: We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites. Conclusions: Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.Telemedicine and e-Health 09/2014; 20(11). DOI:10.1089/tmj.2014.0015 · 1.54 Impact Factor