title: ICU Telemedicine Comanagement Methods and Length of Stay.
abstract: BACKGROUND
  Studies have identified processes that are associated with more favorable length of stay (LOS) outcomes when an ICU telemedicine program is implemented. Despite these studies, the relation of the acceptance of ICU telemedicine management services by individual ICUs to LOS outcomes is unknown.
  
  
  METHODS
  This is a single ICU telemedicine center study that compares LOS outcomes among three groups of intensivist-staffed mixed medical-surgical ICUs that used alternative comanagement strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders was compared among ICUs that used a monitor and notify comanagement approach, a direct intervention with timely notification process, and ICUs that used a mix of these two approaches. The primary outcome was acuity-adjusted hospital LOS.
  
  
  RESULTS
  ICUs that used the direct intervention with timely notification strategy had a significantly larger proportion of provider orders recorded by ICU telemedicine physicians than the mixed methods of comanagement group, which had a larger proportion than ICUs that used the monitor and notify method (P < .001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification comanagement strategy (0.68; 0.65-0.70) compared with the mixed methods group (0.70 [0.69-0.72]; P = .01), which was significantly lower than the monitor and notify group (0.83 [0.80-0.86]; P < .001).
  
  
  CONCLUSIONS
  Direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter LOS outcomes than monitor and notify comanagement strategies.
authors.affiliation: School of Education, Colorado State University, Fort Collins, CO.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Hawkins
authors.affiliation: Departments of Medicine, Anesthesiology, and 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.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: Health Management, Banner Health, Phoenix, AZ.
authors.forename: David A
authors.initials: DA
authors.lastname: Kaster
authors.affiliation: Health Management, Banner Health, Phoenix, AZ; Banner-University Medicine Division, Banner Health, Phoenix, AZ.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Groves
authors.affiliation: Health Management, Banner Health, Phoenix, AZ; Banner-University Medicine Division, Banner Health, Phoenix, AZ. Electronic address: Hargobind.Khurana@bannerhealth.com.
authors.forename: Hargobind
authors.initials: H
authors.lastname: Khurana
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003422:Critical Care / Q000379:methods*; D061345:Early Medical Intervention; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*
keywords: critical care; outcomes; process of care; telemedicine