Telemed J E Health - centralized monitoring and virtual consultant models of tele-icu care: a systematic review.

Tópicos

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Resumo

CKGROUND: Increasing intensivist shortages and demand coupled with the escalating cost of care have created enthusiasm for intensive care unit (ICU)-based telemedicine ("tele-ICU"). This systematic literature review compares the Centralized Monitoring and Virtual Consultant tele-ICU Models.MATERIALS AND METHODS: With an experienced medical reference librarian, we identified all language publications addressing the employment and efficacy of the centralized monitoring and virtual consultant tele-ICU systems through PubMed, CINAHL, and Web of Science. We performed quantitative and qualitative reviews of documents regarding financial sustainability, clinical outcomes, and ICU staff workflow and acceptance.RESULTS: Of 1,468 documents identified, 1,371 documents were excluded, with the remaining 91 documents addressing clinical outcomes (46 documents [enhanced guideline compliance, 5; mortality and length of stay, 28; and feasibility, 13]), financial sustainability (9 documents), and ICU staff workflow and acceptance (36 documents). Quantitative review showed that studies evaluating the Centralized Monitoring Model were twice as frequent, with a mean of 4,891 patients in an average of six ICUs; Virtual Consultant Model studies enrolled a mean of 372 patients in an average of one ICU. Ninety-two percent of feasibility studies evaluated the Virtual Consultant Model, of which 50% were in the last 3 years. Qualitative review largely confirmed findings in previous studies of centralized monitoring systems. Both the Centralized Monitoring and Virtual Consultant Models showed clinical practice adherence improvement. Although definitive evaluation was not possible given lack of data, the Virtual Consultant Model generally indicated lean absolute cost profile in contrast to centralized monitoring systems.CONCLUSIONS: Compared with the Virtual Consultant tele-ICU Model, studies addressing the Centralized Monitoring Model of tele-ICU care were greater in quantity and sample size, with qualitative conclusions of clinical outcomes, staff satisfaction and workload, and financial sustainability largely consistent with past systematic reviews. Attention should be focused on performing more high-quality studies to allow for equitable comparisons between both models.

Resumo Limpo

ckground increas intensivist shortag demand coupl escal cost care creat enthusiasm intens care unit icubas telemedicin teleicu systemat literatur review compar central monitor virtual consult teleicu modelsmateri method experienc medic refer librarian identifi languag public address employ efficaci central monitor virtual consult teleicu system pubm cinahl web scienc perform quantit qualit review document regard financi sustain clinic outcom icu staff workflow acceptanceresult document identifi document exclud remain document address clinic outcom document enhanc guidelin complianc mortal length stay feasibl financi sustain document icu staff workflow accept document quantit review show studi evalu central monitor model twice frequent mean patient averag six icus virtual consult model studi enrol mean patient averag one icu ninetytwo percent feasibl studi evalu virtual consult model last year qualit review larg confirm find previous studi central monitor system central monitor virtual consult model show clinic practic adher improv although definit evalu possibl given lack data virtual consult model general indic lean absolut cost profil contrast central monitor systemsconclus compar virtual consult teleicu model studi address central monitor model teleicu care greater quantiti sampl size qualit conclus clinic outcom staff satisfact workload financi sustain larg consist past systemat review attent focus perform highqual studi allow equit comparison model

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