title: Using electronic medical record notes to measure ICU telemedicine utilization.
abstract: Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered. Interactions were assessed based on initiation site, bedside initiator, contact type, and patient care change. Of 14 511 ICU admissions with teleintensivist access, teleintensivist interaction was documented in 21.6% (N = 3136). In particular, contacts were primarily initiated by bedside staff (74.4%), use increased over time, and of contacts resulting in changes in patient care, most were initiated by a bedside nurse (84.3%). Given this variation, future research necessitates inclusion of utilization in evaluation of Tele-ICU and patient outcomes.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA.|Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Amy M J
authors.initials: AMJ
authors.lastname: O'Shea
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA.|Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan Sarrazin
authors.affiliation: Iowa City VA Health Care System.|Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine.
authors.forename: Boulos
authors.initials: B
authors.lastname: Nassar
authors.affiliation: Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: VA Integrated Healthcare Network 10, VA Healthcare System, Cincinnati, OH, USA.
authors.forename: Lynelle
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Minneapolis VA Health Care System, Minneapolis, MN, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bonello
authors.affiliation: Pulmonary, Critical Care, and Sleep Division and Cincinnati Tele-ICU, Cincinnati VAMC, Cincinnati, OH, USA.|Pulmonary, Critical Care, and Sleep Division, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA.|Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Reisinger
mesh_terms: D057286:Electronic Health Records; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D015146:Midwestern United States; D019982:Organizational Case Studies; D017216:Telemedicine / Q000706:statistics & numerical data*
keywords: United States Department of Veterans Affairs; critical care; intensive care units; telemedicine; veterans