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Abstract

Introduction: This study sought to determine if TeleICU directed daily ventilator rounds led to improved adherence to low tidal volume(Vt) ventilation, reduced (APACHE IV adjusted) Ventilator Duration Ratio (VDR),ICU and hospital mortality ratio, and ICU LOS. Hypothesis: We hypothesized that TeleICU directed process improvement initiatives could improve outcomes across disparate practice. Methods: Nine community hospital ICUs participating in TeleICU directed daily structured ventilator rounds were enrolled in this retrospective longitudinal quarterly analysis of adherence to low Vt strategy(<7.5ml/kg IBW for P/F<300), VDR, ICU and hospital mortality ratios, and ICU LOS. The independent TeleICU practice utilized Philips VISICU licensed eCare Manager(tm) platform, providing ICU care and process improvement. Data were extracted from the proprietary database. Ventilator rounds were led byTeleICU physicians using audiovisual links to patients, bedside RTs and RNs. Ventilator settings, ABG, CXR and liberation readiness parameters were pre-entered into an electronic spreadsheet by TeleICU CCRNs and NPs. Results: Prior to ventilator rounds implementation there was wide variation in hospital adherence to low Vt strategy [mean 26%; SD 18.4;range 13-69%]. Significant quarterly improvement was seen in all hospitals after implementation [32.6, 43.2 and 42% Q1,2,3; p<0.001 by two tail Fisher exact test]. VDR also showed pre-implementation variability [mean 1.16;SD 0.52; range 0.64-2.0] and showed improved trending throughout the study [quarterly VDR 0.89, 0.84 and 0.88; range 0.63-1.4; p=NS]. ICU mortality ratio demonstrated longitudinal improvement that reached significance after the second quarter post-implementation [0.94 pre- v. 0.8, 0.73 and 0.67 post-implementation; p<0.03 pre- v. Q2]. ICU LOS and hospital mortality ratio were not significantly changed. Conclusions: Variable practices among ICUs pose challenges to TeleICU led process improvement. Despite this, implementation of TeleICU ventilator rounds was associated with improved and durable adherence to low Vt strategies and significant reduction in mortality.