JAMA: Bedside clinicians played key role in tele-ICU study
Netherlands researchers raised questions about a study published in the June edition of the Journal of the American Medical Association (JAMA) that reported an association between the implementation of a tele-ICU and improved mortality, shorter lengths of stay, and stricter adherence to best practices.
Hennie A. Metske, MD, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands, and colleagues questioned the report’s finding that tele-intensivists initiated 77 times more interventions for physiological instability than did bedside clinicians, as reported by Craig M. Lilly, MD, University of Massachusetts Memorial Medical Center, et al, in the study.
“This suggests bedside clinicians initiated hardly any interventions. Bedside interventions may be underreported in comparison with digitized decision making,” suggested Metske et al, in a letter to the editor. “Alternatively, interventions by tele-intensivists may have been initiated during off hours, when the number of attending clinicians was low, making the high ratio of tele-intensivists more understandable.”
Metske and colleagues added that while promising, the effects of tele-ICUs may vary depending on staffing levels. To translate the findings to other ICUs, they asked for elaboration on the numbers.
In a response, Lilly et al acknowledged that the positive outcomes were dependent upon the ability of the intervention to change processes and behaviors. While the authors reported that tele-intensivists initiated 37,573 interventions during their study period—while bedside clinicians initiated 483—Lilly et al indicated that those numbers did not include "episodes in which bedside clinicians intervened without support from the off-site team."
Also, the study reported that 5.1 of 6.8 alerts (75 percent) for episodes of physiological instability per patient per day were managed by bedside physicians with tele-intensivists only monitoring the outcome. The other 25 percent of alerts were managed with collaboration.
“The clinical sense of Metske et al is correct; bedside critical care professionals recognized and responded effectively to the majority of alerts and alarms without help from the off-site team," wrote Lilly and colleagues. "Among 37,573 interventions, we identified 24,426 that affected the care plan and determined that bedside clinicians recognized the episode of physiological instability and asked the off-site team for assistance 483 times and that off-site clinicians initiated communication with bedside physicians for 23,943 episodes.”
Hennie A. Metske, MD, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands, and colleagues questioned the report’s finding that tele-intensivists initiated 77 times more interventions for physiological instability than did bedside clinicians, as reported by Craig M. Lilly, MD, University of Massachusetts Memorial Medical Center, et al, in the study.
“This suggests bedside clinicians initiated hardly any interventions. Bedside interventions may be underreported in comparison with digitized decision making,” suggested Metske et al, in a letter to the editor. “Alternatively, interventions by tele-intensivists may have been initiated during off hours, when the number of attending clinicians was low, making the high ratio of tele-intensivists more understandable.”
Metske and colleagues added that while promising, the effects of tele-ICUs may vary depending on staffing levels. To translate the findings to other ICUs, they asked for elaboration on the numbers.
In a response, Lilly et al acknowledged that the positive outcomes were dependent upon the ability of the intervention to change processes and behaviors. While the authors reported that tele-intensivists initiated 37,573 interventions during their study period—while bedside clinicians initiated 483—Lilly et al indicated that those numbers did not include "episodes in which bedside clinicians intervened without support from the off-site team."
Also, the study reported that 5.1 of 6.8 alerts (75 percent) for episodes of physiological instability per patient per day were managed by bedside physicians with tele-intensivists only monitoring the outcome. The other 25 percent of alerts were managed with collaboration.
“The clinical sense of Metske et al is correct; bedside critical care professionals recognized and responded effectively to the majority of alerts and alarms without help from the off-site team," wrote Lilly and colleagues. "Among 37,573 interventions, we identified 24,426 that affected the care plan and determined that bedside clinicians recognized the episode of physiological instability and asked the off-site team for assistance 483 times and that off-site clinicians initiated communication with bedside physicians for 23,943 episodes.”