title: A national ICU telemedicine survey: validation and results.
abstract: BACKGROUND
  A recent ICU telemedicine research consensus conference identified the need for reliable methods of measuring structural features and processes of critical care delivery in the domains of organizational context and characteristics of ICU teams, ICUs, hospitals, and of the communities supported by an ICU.
  
  
  METHODS
  The American College of Chest Physicians Critical Care Institute developed and conducted a survey of ICU telemedicine practices. A 32-item survey was delivered electronically to leaders of 311 ICUs, and 11 domains were identified using principal components analysis. Survey reliability was judged by intraclass correlation among raters, and validity was measured for items for which independent assessment was available.
  
  
  RESULTS
  Complete survey information was obtained for 170 of 311 ICUs sent invitations. Analysis of a subset of surveys from 45 ICUs with complete data from more than one rater indicated that the survey reliability was in the excellent to nearly perfect range. Coefficients for measures of external validation ranged from 0.63 to 1.0. Analyses of the survey revealed substantial variation in the practice of ICU telemedicine, including ICU telemedicine center staffing patterns; qualifications of providers; case sign-out, ICU staffing models, leadership, and governance; intensivist review for new patients; adherence to best practices; use of quality and safety information; and ICU physician sign out for their patients.
  
  
  CONCLUSIONS
  The American College of Chest Physicians ICU telemedicine survey is a reliable tool for measuring variation among ICUs with regard to staffing, structure, processes of care, and ICU telemedicine practices.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA; Department of Anesthesiology, University of Massachusetts Medical School, Worcester, MA; Department of Surgery, University of Massachusetts Medical School, Worcester, MA; Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA. Electronic address: craig.lilly@umassmed.edu.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Fisher
authors.affiliation: Advocate HealthCare, Rush University Medical Center, Chicago, IL; NorthShore University Health System, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Ries
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.affiliation: NorthShore University Health System, Chicago, IL; Feinberg School of Medicine, Northwestern University, Evanston, IL.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Vender
authors.affiliation: American College of Chest Physicians, Northbrook, IL.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Pitts
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: C William
authors.initials: CW
authors.lastname: Hanson
mesh_terms: D003625:Data Collection / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D015203:Reproducibility of Results; D017216:Telemedicine / Q000592:standards*; D014481:United States