Tele-ICU System and Staffing Model

Details on on-site ICU physician coverage, the Tele-ICU staffing, and daily tasks of the Tele-ICU team are showed in Fig. 1. The Tele-ICU system (eCareManager® 4.1, Philips, U.S.A) used in the study supports the decision-making process by patient information centralization and real-time physiological severity evaluation based on automatic analysis (Fig. 2). The Tele-ICU staff consists of a board-certified intensivist, specially trained nurses, and a clerical assistant to the doctor. One nurse is responsible for up to 50 patients. A support center nurse is stationed 24/7. Daily Tele-ICU team tasks involve communication with on-site staff and patients using a secured audio–video system on demand and proactive survey of high risk or physiologically worsening patients to prevent unfavorable events. Venous thrombosis prophylaxis, stress ulcer prophylaxis, medication dosing appropriateness such as catecholamines, vasopressor, analgesics and sedatives, recommendation of early mobilization, early enteral feeding, and sepsis management were included in the tasks. Because the role of Tele-ICU is severity evaluation and advice in this study, the Tele-ICU physicians do not order instead of the on-site physician and only record the contents of the consultation. In addition, as the Tele-ICU physicians expertise in respiratory care and lung protective ventilation, they performed scheduled and/or on demand respiratory round. Tele-ICU physicians are given full authority of bed placement and transfer in university hospital ICU.Fig. 1

Details on on-site ICU physician coverage, the Tele-ICU staffing, and daily tasks of the Tele-ICU of Showa University Hospital

Fig. 2

Outlines of the Tele-ICU system used in the study. BGA blood gas analysis, GCS Glasgow Coma Scale, RASS Richmond agitation–sedation scale, ICDSC Intensive Care Delirium Screening Checklist, CAM–ICU Confusion Assessment Method for the ICU, NMBA neuromuscular blocking agent, ECMO extracorporeal membrane oxygenation, IABP intra-aortic balloon pumping, VAD ventricular assist device, RRT renal replacement therapy