Archives of internal medicine
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Review Meta Analysis
Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis.
Although remote intensive care unit (ICU) coverage is rapidly being adopted to enhance access to intensivists, its effect on patient outcomes is unclear. We conducted a meta-analysis to examine the impact of telemedicine ICU (tele-ICU) coverage on mortality and length of stay (LOS). ⋯ Tele-ICU coverage is associated with lower ICU mortality and LOS but not with lower in-hospital mortality or hospital LOS.
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Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40% increased risk of acquisition, presumably through environmental contamination. Subsequently, a cleaning intervention was shown to reduce MRSA and VRE room contamination. We now evaluate the effect of this intervention on the risk of acquiring MRSA and VRE from prior room occupants. ⋯ Enhanced intensive care unit cleaning using the intervention methods may reduce MRSA and VRE transmission. It may also eliminate the risk of MRSA acquisition due to an MRSA-positive prior room occupant.
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Editorial Comment
Intensive care unit telemedicine: promises and pitfalls.
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Sepsis is common, highly morbid, and costly, yet little is known about differences in the care or outcomes of patients with sepsis across hospitals. We sought to characterize variations in hospital spending and mortality rates and to determine whether higher levels of spending are associated with better hospital survival. ⋯ Hospital spending and adjusted mortality rates for patients with sepsis vary substantially, but higher hospital expenditures are not associated with better survival. Efforts to enhance the value of sepsis care could be modeled on hospitals that achieve lower-than-expected mortality and costs.