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Table 2 Characteristics of included studies

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

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