From: Telemedicine with clinical decision support for critical care: a systematic review
Study | Country | Number of ICUs | Type of hospital | ICU model and staffing | Baseline standards | Existing IT infrastructure | Vendor | Funding source | Design (EPOC criteria) | Sample | Duration | Outcomes |
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Lilly et al. (2011) | USA | 7 adult ICUs (medical, cardiovascular, and surgical) across 2 campuses 834 beds | Academic centre Suburban/community setting | Closed model of care Intensivist cover 24/7 Night-time cover at the discretion of the bedside ICU house staff Each ICU had a nurse manager and a medical director Bedside care provided by physicians in training, nurse practitioners, and physician assistants. 1:1 or 1:2 nurse to patient ratios Respiratory therapist also provided 24/7 cover to each unit | 1 year prior to intervention: standardisation of best practice in all units (prevention of venous thrombosis, cardiovascular complications, ventilator-associated pneumonia, and stress ulcers) and introduction of ICU daily goals | 1 unit: electronic record system 6 units: paper-based patient records | Philips VISICU (Baltimore, MD), APACHE® (Cerner, Kansas City, MO) with additional components provided by UMass Critical Care | University of Massachusetts | Controlled before-after study (prospective unblinded stepped-wedge design) 7 steps; duration of time intervals between steps varied from 1 day to 5 months | 6290 cases: 1529 control subjects, 4761 intervention subjects | Pre-intervention: April 26, 2005–February 7, 2007 Intervention period: August 6, 2006–September 30, 2007 | Primary: hospital and ICU mortality Secondary: hospital and ICU length of stay, best practice adherence, complication rates |
Lilly et al. (2014) | USA | 38 hospitals 56 adult ICUs (medical, surgical, coronary care, neuroscience, cardiothoracic) | Non-teaching, teaching, and teaching affiliated with a university or academic centre Rural, suburban and urban settings within 15 US states, 19 healthcare systems | Not reported | Not reported | Each ICU implemented similar technical components, including audio and video connections, an ICU-focused medical record, and software for detecting evolving physiologic instability (Koninklijke Philips N.V.) | VISICU, now owned by Koninklijke Philips N.V. | University of Massachusetts | Controlled before-after study (non-randomised, unblinded, pre-/post-design) 8-week run-in exclusion period between the start of intervention and recruitment of the first intervention subjects | 118,990 cases: 11,558 control subjects, 107,432 intervention subjects | Pre-intervention: May 16, 2003–end not reported Intervention period: start not reported–December 31, 2008 | Primary: hospital mortality Secondary: ICU mortality, hospital and ICU length of stay |