Critical care clinics
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Critical care clinics · Apr 2015
ReviewIncreasing Quality Through Telemedicine in the Intensive Care Unit.
This article explores the hypothesis that a telemedicine intensive care unit (Tele-ICU) platform is uniquely suited to facilitate quality performance improvement (PI). This article addresses some substantial hurdles to overcome that may limit the effectiveness of a Tele-ICU platform to achieve PI objectives. Lastly, this article describes the author's experience with a PI project to improve ventilator management conducted via a Tele-ICU hub interacting with 11 geographically dispersed ICUs. Using this example to illustrate the concepts, the author hopes to shed some light on the successes and lessons learned so as to generate best-practice guidelines for Tele-ICU-directed PI initiatives.
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Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedsides of critically ill children. Telemedicine use is increasing and will be a common in remote emergency departments, inpatient wards, and intensive care units for pediatric care. Hospitals and physicians that use telemedicine technologies provide higher quality of care, are more efficient in resource use with improved cost-effectiveness, and have higher satisfaction among patients, parents, and remote providers. More research will result in improved access to pediatric critical care expertise.
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Critical care clinics · Apr 2015
ReviewTelemedicine in the Intensive Care Unit: Its Role in Emergencies and Disaster Management.
Disasters and emergencies lead to an overburdened health care system after the event, so additional telemedicine support can improve patient outcomes. If telemedicine is going to become an integral part of disaster response, there needs to be improved preparation for the use of telemedicine technologies. Telemedicine can improve patient triage, monitoring, access to specialists, health care provider burnout, and disaster recovery. However, the evidence for telemedicine and tele-intensive care in the disaster setting is limited, and it should be further studied to identify situations in which it is the most clinically effective and cost-effective.
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Telestroke and teleneurologic intensive care units (teleneuro-ICUs) optimize the diagnosis and treatment of neurologic emergencies. Establishment of a telestroke or teleneuro-ICU program relies on investment in experienced stroke and neurocritical care personnel as well as advanced telecommunications technologies. Telemanagement of neurologic emergencies can be standardized to improve outcomes, but it is essential to have a relationship with a tertiary care facility that can use endovascular, neurosurgical, and neurocritical care advanced therapies after stabilization. The next stage in telestroke/teleneuro-ICU management involves the use of mobile stroke units to shorten the time to treatment in neurocritically ill patients.
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Severe sepsis remains a significant medical problem affecting up to 18 million individuals worldwide. Mortality remains high ranging between 28% and 50%. ⋯ Technology associated with telemedicine may help in screening, identifying, and monitoring the attainment of the severe sepsis bundle elements in a timely manner. However, the heterogeneity of systemic inflammatory response syndrome and clinical assessment necessary to diagnose and assess patients with severe sepsis makes technology alone insufficient to improve the outcomes in these patients.