Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial

• DOI: 10.1007/s00134-022-06949-x
• Publication Date: 2023-01-16T12:03:03Z
• Authors: Claudia D. Spies; Nicolas Paul; Christine Adrion; Elke Berger; Reinhard Busse; Ben Kraufmann; Ursula Marschall; Simone Rosseau; Claudia Denke; Henning Krampe; Enrico Dähnert; Ulrich Mansmann; Björn Weiss; ; Moritz F. Adam; Lucas Albers; Nicolai Andrees; Stefan Angermair; Felix Balzer; Sascha Bartsch; Sabine Becherer; Sebastian Boie; Jan-Peter Braun; Felix Busch; Askin Büyüközer; Jörg Caumanns; Jonas Cittadino; Eva M. Düllmann; Andreas Edel; Lisa Eymold; Cynthia S. Franke; Georg Fritz; Martina Gaßner; Alexander Geissler; Maximilian Goedecke; Susanne Görtzen; Julius Grunow; Edmund Hartung; Stefan Heidemann; Beata Hennig; Julian Herm; Anja Heymann; Moritz Höft; Jürgen Janke; Hans-Joachim Janssen; Marc Kastrup; Thomas Kibat; Sascha Kirsten; Robin Kleinwächter; Wilma Klink; Tobias Klöpper; Anna-C. Knauthe; Jens-Peter König; Thomas König; Max R. Krautz; Philipp Landgraf; Carola Loock; Ralf Lorenz; Alexandr Melnikov; Belinda Memmert; Mario Menk; Tobias Moormann; Lutz Nibbe; Stephan Niemetz; Michele Ocken; Michael Oppert; Mareen Pigorsch; Christian Pille; Ivo Pobering; Birgit Puhlmann; Melanie Rahmel; Stephan-Matthias ...; Elena L. Ribet Buse; Susanne Röber; Steffen Rohde; Arne Röhrs; Max Rosenthal; Kerstin Roßberg; Kay Rumschüßel; Ulf Sander; Carsten Sanft; Maren Schmidt; Maximilian Schmidt; Sebastian Schmidt; Marc Schmittner; Julika Schön; Torsten Schröder; Franziska Staerck; Karin Steinecke; Sascha Tafelski; Sascha Treskatsch; Marlies Vogler; Steffen Weber-Car...; Dirk Weiland; Renata Wojcik
• Keywords: Pain medicine; Telehealth

Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated effectiveness a multifaceted telemedical programme on adherence to German quality indicators (QIs) in regional network units (ICUs) Germany. conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with expected stay ≥ 24 h. Twelve clusters Berlin Brandenburg were randomly assigned three sequence groups transition from control (standard care) intervention condition (telemedicine). The improvement consisted daily rounds guided by eight acute QIs expert consultations. Co-primary outcomes patient-specific (fulfilled yes/no) QIs, assessed central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. study is completed registered ClinicalTrials.gov (NCT03671447). Between September 4, 2018, March 31, 2020, 1463 (414 treated control, 1049 condition) enrolled at ten clusters, resulting 14,783 evaluated days. Two recruited no (one withdrew informed consent; one dropped out). intervention, as implemented, significantly increased QI performance "sedation, analgesia delirium" (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395–8.358), "ventilation" (OR 2.248, 1.198–4.217), "weaning ventilation" 9.049, 2.707–30.247), "infection management" 4.397, 1.482–13.037), "enteral nutrition" 1.579, 1.032–2.416), "patient family communication" 6.787, 3.976–11.589), "early mobilisation" 3.161, 2.160–4.624). No evidence difference "daily multi-professional interdisciplinary clinical visits" between both conditions was found 1.606, 0.780–3.309). Temporal trends related unrelated detected. 149 died during their index (45 104 condition). A program seven evidence-based care. These results need further confirmation broader setting regional, non-academic community hospitals other healthcare systems.