title: Using nursing expertise and telemedicine to increase nursing collaboration and improve patient outcomes.
abstract: OBJECTIVE
  To examine the impact of the first nurse-implemented tele-intensive care unit (tele-ICU) staffing model, with the intent that shared nursing vigilance and collaboration can decrease patient complications potentially impacting patient outcomes.
  
  
  METHODS
  A quantitative study used a pre-post program design of 90 staff nurses in the Adult Critical Care Unit, 10 tele-ICU nurses, and 1,308 patient participants at Providence Alaska Medical Center (Anchorage, AK). Twelve months of baseline data were collected: Acute Physiology and Chronic Health Evaluation severity-adjusted ICU length of stay (LOS), ICU mortality, protocols for the prevention of ventilator-associated pneumonia (VAP), ventilator bundle compliance (stress ulcer and venous thrombosis prophylaxis), and glucose control. Follow-up data were obtained using the same outcomes examined for baseline: 9 months for the nurse and only an additional 3 months with the addition of physician monitoring services.
  
  
  RESULTS
  Data demonstrated post-tele-ICU implementation improvements as follows: severity-adjusted LOS decrease, 15% (222 patient-days saved); severity-adjusted ICU mortality decrease, 14% (20 lives saved); compliance improvement of "at-risk" patients, restraint documentation 26% improvement; ventilator bundle compliance, 6% increase; and VAP, 13% decrease in patient-days.
  
  
  CONCLUSIONS
  Collaboration between bedside and remote nurses in conjunction with the use of tele-ICU program technology positively impacts critical care patient outcomes. Effective nursing collaboration and communication and improved patient outcomes can be attained through nursing vigilance and attention to best practices or health system protocols and the use of smart technology such as the population management tools in the tele-ICU program.
authors.affiliation: Providence Alaska Medical Center, Anchorage, Alaska, USA.
authors.forename: Cecilee
authors.initials: C
authors.lastname: Ruesch
authors.forename: Jackie
authors.initials: J
authors.lastname: Mossakowski
authors.forename: Janine
authors.initials: J
authors.lastname: Forrest
authors.forename: Mary
authors.initials: M
authors.lastname: Hayes
authors.forename: Mary
authors.initials: M
authors.lastname: Jahrsdoerfer
authors.forename: Elaine
authors.initials: E
authors.lastname: Comeau
authors.forename: Mary
authors.initials: M
authors.lastname: Singleton
mesh_terms: D019985:Benchmarking; D002983:Clinical Competence; D003299:Cooperative Behavior; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D009026:Mortality / Q000639:trends; D009729:Nursing; D009741:Nursing Staff, Hospital; D005791:Patient Care / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D036301:Qualitative Research; D017216:Telemedicine / Q000191:economics*; D016896:Treatment Outcome; D014481:United States