A recent intensive care unit (ICU) telemedicine research consensus conference identified the need for reliable methods of measuring structural features and processes of critical care delivery in the domains of organizational context, characteristics of ICU teams, ICUs, hospitals, and of the communities supported by an ICU.
The American College of Chest Physicians Critical Care Institute developed and conducted a survey of ICU tele-medicine practices. A 32 item survey was delivered electronically to leaders of 311 intensive care units and 11 domains were identified using principal component analysis. Survey reliability was judged by intra class correlation among raters and validity was measured for items for which independent assessment was available.
Complete survey information was obtained for 170 of 311 ICUs sent invitations. Analysis of a subset surveys from 45 ICUs with complete data from more than one rater indicated that the survey reliability was in the excellent to nearly perfect range. Coefficients for measures of external validation ranged from 0.63 to 1.0. Analyses of the survey revealed substantial variation in the practice of ICU-telemedicine including, tele-ICU staffing patterns, qualifications of providers, case sign out, ICU staffing models, leadership, and governance, intensivist review for new patients, adherence to best practices, use of quality and safety information, and ICU physician sign out for their patients.
The ACCP ICU-telemedicine survey is a reliable tool for measuring variation among ICUs with regard to staffing, structure, processes of care, and ICU telemedicine practices.
Lilly, Craig M.; Fisher, Kimberly A.; Ries, Michael; Pastores, Stephen M.; Vender, Jeffery; Pitts, Jennifer A.; Hanson, C. William, Chest, Online first, DOI: 10.1378/chest.12-0310