乐胖代购免代理版

{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T05:27:43Z","timestamp":1730870863937,"version":"3.28.0"},"reference-count":46,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2024,1]]},"abstract":"Abstract<\/jats:title>\n Background\u2003Unplanned intensive care unit (ICU) admissions from medical\/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs.<\/jats:p>\n Methods\u2003We conducted a qualitative study involving general observations of the units, shadowing of clinicians during patient transfers, and interviews with clinicians from the ED, medical\/surgical floor units and their ICU counterparts, tele-ICU, and the rapid response team at a large academic medical center in St. Louis, Missouri, United States. We used a hybrid thematic analysis approach supported by open and structured coding using the Consolidated Framework for Implementation Research (CFIR).<\/jats:p>\n Results\u2003Over 165\u2009hours of observations\/shadowing and 26 clinician interviews were conducted. Our findings suggest that a tele-critical care consult (TC3) service can prevent avoidable, lower acuity ICU admissions by offering a second set of eyes via remote monitoring and providing guidance to bedside and rapid response teams in the care delivery of these patients on the floor\/ED. CFIR-informed enablers impacting the successful implementation of the TC3 service included the optional and on-demand features of the TC3 service, around-the-clock availability, and continuous access to trained critical care clinicians for avoidable lower acuity (ALA) patients outside of the ICU, familiarity with tele-ICU staff, and a willingness to try alternative patient risk mitigation strategies for ALA patients (suggested by TC3), before transferring all unplanned admissions to ICUs. Conversely, the CFIR-informed barriers to implementation included a desire to uphold physician autonomy by floor\/ED clinicians, potential role conflicts with rapid response teams, additional workload for floor\/ED nurses, concerns about obstructing unavoidable, higher acuity admissions, and discomfort with audio-visual tools. To amplify these potential enablers and mitigate potential barriers to TC3 implementation, informed by this study, we propose two key characteristics\u2014essential for extending the delivery of critical care services beyond the ICU\u2014underlying a telemedicine critical care consultation model including its virtual footprint and on-demand and optional service features.<\/jats:p>\n Conclusion\u2003Tele-critical care represents an innovative strategy for delivering safe and high-quality critical care services to lower acuity borderline patients outside the ICU setting.<\/jats:p>","DOI":"10.1055\/s-0044-1780508","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:53:47Z","timestamp":1709772827000},"page":"178-191","source":"Crossref","is-referenced-by-count":2,"title":["Expanding Critical Care Delivery beyond the Intensive Care Unit: Determining the Design and Implementation Needs for a Tele-Critical Care Consultation Service"],"prefix":"10.1055","volume":"15","author":[{"given":"Joanna","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States"},{"name":"Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States"}]},{"given":"Madhumitha","family":"Kandasamy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States"}]},{"given":"Bradley","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States"}]},{"given":"Lisa","family":"Konzen","sequence":"additional","affiliation":[{"name":"Barnes-Jewish Hospital, St. Louis, Missouri, United States"}]},{"given":"Jason","family":"White","sequence":"additional","affiliation":[{"name":"Barnes-Jewish Hospital, St. Louis, Missouri, United States"}]},{"given":"Anne","family":"Drewry","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States"}]},{"given":"Christopher","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States"},{"name":"Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, United States"}]}],"member":"194","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"volume-title":"Utilization of Intensive Care Services,","year":"2011","author":"M L Barrett","key":"ref1"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/00003246-199302000-00022","article-title":"Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization","volume":"21","author":"J S Groeger","year":"1993","journal-title":"Crit Care Med"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1097\/CCM.0000000000000932","article-title":"One fourth of unplanned transfers to a higher level of care are associated with a highly preventable adverse event: a patient record review in six Belgian hospitals","volume":"43","author":"K Marquet","year":"2015","journal-title":"Crit Care Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jss.2019.06.059","article-title":"Unplanned ICU admission is associated with worse clinical outcomes in geriatric trauma patients","volume":"245","author":"H E Mulvey","year":"2020","journal-title":"J Surg Res"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jcrc.2016.02.012","article-title":"Unplanned intensive care unit admission following trauma","volume":"33","author":"J A Rubano","year":"2016","journal-title":"J Crit Care"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1513\/AnnalsATS.201905-366OC","article-title":"Potentially preventable intensive care unit admissions in the United States, 2006-2015","volume":"17","author":"G E Weissman","year":"2020","journal-title":"Ann Am Thorac Soc"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1002\/jhm.2193","article-title":"A randomized trial of real-time automated clinical deterioration alerts sent to a rapid response team","volume":"9","author":"M H Kollef","year":"2014","journal-title":"J Hosp Med"},{"issue":"S 04","key":"ref8","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.injury.2009.10.033","article-title":"Prehospital care - 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