Telemedicine Critical Care
Conditions
Interventions
The study is an open-label, national, multicenter, stepped- wedge cluster randomized controlled trial. The study does not have an experimental group and a control group but rather a control period and
Sponsors
Hospital Israelita Albert Einstein
Hospital Israelita Albert Einstein
Eligibility
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: All patients admitted to the Intensive Care Units (ICUs) included (ICUs of public or philanthropic hospitals; ICUs with a minimum of 7 and a maximum of 20 beds; ICUs with a doctor and nurse available 24 hours a day and a physiotherapist available at least 18 hours a day). Patients aged 18 years or over. Both genders
Exclusion criteria
Exclusion criteria: Intensive Care Units (ICUs)with structured multidisciplinary round more than three times a week conducted by an intensive care physician (certified), documented in the medical record, with a fixed duration (>5 min / patient), using some supporting tool (checklist or standard form), goal oriented, based on established protocols, including all the patients admitted to the ICU. Intensive care units already doing audit and feedback with specific planning. Dedicated coronary care units/cardiac intensive care units or other specialized units (cardiac surgery, neurological, burned patients). Step-down units or semi-intensive cardiac care unit. Intensive care units without availability of substitute renal therapy. ICU coordinator specialist in intensive care medicine and management training (MBA in Health Management or equivalent). Pacients admission for other reasons than medical (e.g., judicial cause, legal reasons, safety reasons). Patients previously included in the TELESCOPE II trial (for the primary outcome analysis)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of stay in the ICU, measured in days, considering the time interval between admission to the ICU and the moment of physical transfer of the patient to another hospital admission area or external transfer. An expectation exists to observe a reduction in the length of stay equivalent to a decrease of 1.1 days compared to the baseline period. | — |
Secondary
| Measure | Time frame |
|---|---|
| Mortality in the Intensive Care Unit;In-hospital mortality, defined as death by any cause during the index hospital admission.;Ventilator-free days during the first 28 days, defined as the number of days alive and free from mechanical ventilation for at least 24 consecutive hours. Patients who died before weaning were deemed to have zero ventilator-free days, and patients discharged from the hospital before 28 days were considered alive and free from mechanical ventilation at 28 days.;ICU readmission within 48 hours. ;Early reintubation (<48h after elective extubation).;Ventilator-associated events, defined as either an increase in the daily minimum positive end-expiratory pressure (PEEP) of =3 cmH2O sustained for at least two consecutive calendar days following a period of at least two days of stable or decreasing PEEP, or an increase in the fraction of inspired oxygen (FiO2) by =20 percentage points sustained for at least two consecutive days after a minimum of two days of stable or decreasing FiO2 levels. ;Accidental extubation rate. | — |
Countries
BR
Contacts
Public ContactAdriano Pereira
Hospital Israelita Albert Einstein
Outcome results
None listed