ABSTRACT
We conducted a retrospective, observational study of patient outcomes in two intensive care units in the same hospital. The surgical ICU (SICU) implemented telemedicine and electronic medical records, while the medical ICU (MICU) did not. Medical charts were reviewed for a one-year period before telemedicine and a one-year period afterwards. In the SICU, records were obtained for 246 patients before and 1499 patients after implementation; in the MICU, records were obtained for 220 patients and 285 patients in the same periods. The outcomes of interest were ICU length of stay and mortality, and hospital length of stay and mortality. Outcome variables were severity-adjusted using APACHE scoring. A bootstrap method, with 1000 replicates, was used to assess stability of the findings. The adjusted ICU length of stay, ICU mortality, and hospital mortality for the SICU patients all decreased significantly after the implementation of telemedicine. There was no change in adjusted outcome variables in the MICU patients. Implementation of telemedicine and electronic records in the surgical ICU was associated with a profound reduction in severity-adjusted ICU length of stay, ICU mortality, and hospital mortality. However, it is not possible to conclude definitively that the observed associations seen in the SICU were due to the intervention.
Subject(s)
Hospital Mortality , Intensive Care Units/organization & administration , Length of Stay/statistics & numerical data , Telemedicine/organization & administration , Analysis of Variance , Critical Care/organization & administration , Humans , Intensive Care Units/statistics & numerical data , Retrospective StudiesABSTRACT
We describe and report the results of an evaluation of a smart alarm algorithm for post coronary artery bypass graft (CABG) patients. The algorithm (CABG-SA) was applied to vital sign data streams recorded in a surgical intensive care unit (SICU) at a hospital in the University of Pennsylvania Health System. In order to determine the specificity of CABG-SA, the alarms generated by CABG-SA were compared against the actual interventions performed by the staff of the critical care unit. Overall, CABG-SA alarmed for 55% of the time relative to traditional alarms while still generating alarms for 12 of the 13 recorded interventions.
