ACCP Critical Care Institute Tele-ICU Survey 2009

Which of the following best describes the setting of your hospital?

Rural

Urban

Suburban

What is the approximate population of the city where your hospital is located?

Population of less than 100,000

Population of 100,000 to 999,999

Population of 1 million or more

What is the teaching status of the hospital?

Non-teaching

Teaching, but non-university affiliated

Major academic medical center- university affiliated

Other

What is the teaching status of the ICU?

Residents do not work in the ICU

Residents cover some patients, but not all

Residents cover all patients

Other

Please review the list below and indicate the type of support provided by the Information Systems (IS) group to the tele-ICU at your institution.
(Off-hours coverage is assumed in all cases to be off-site)

Full time on-site IS analyst that is a member of the tele-ICU team

Full time IS analyst(s) who is not on the tele-ICU team

Full time off-site consultant analyst(s)

Part time off-site consultant analyst(s)

Regular support provided only by tele-ICU vendor

How much of the Medical Director’s time is dedicated to the administration of the tele-medicine program?

FULL TIME – spends 100% of their time on ICU or tele-ICU patient care and administration (holds no other job responsibilities)

MOST OF THE TIME – spends 50%-99% of their time on ICU or tele-ICU patient care and administration

PART TIME – spends 15% to 49% of their time on ICU or tele-ICU patient care and administration

SOME TIME – spends less than 15% of their time on ICU or tele-ICU patient care and administration

No Medical Director

What percentage of tele-ICU physicians at the hospital hold active sub-specialty certification in Critical Care Medicine from the American Board of Internal Medicine, the American Board of Surgery or the American Board of Anesthesiology?
(Please indicate a percentage. If you are not sure, please give your best guess.)

What percentage of the non-physician staff that actively monitor patients hold advance certification for the care of actually and/or critically ill patients, such as Progressive Care Certified Nurse (PCCN), Critical Care Registered Nurse (CCRN) (adult or pediatric), Critical Care Clinical Nurse Specialist (CCNS), or Acute Care Nurse Practitioner (ACNP)?
(Please indicate a percentage. If you are not sure, please give your best guess.)

What percentage of tele-ICU Intensivists also work at the bedside in the ICUs being supported by the tele-ICU intervention?
(Please indicate a percentage. If you are not sure, please give your best guess.)

What percentage of tele-ICU Nurses or Affiliate Practitioners (NP or PA) also work at the bedside in the ICUs being supported by the tele-ICU intervention?
(Please indicate a percentage. If you are not sure, please give your best guess.)

The following questions are phrased to allow comparison of your ICU structure before and after introduction of the tele-ICU program, so in some cases your responses may be the same.

BEFORE implementation of tele-ICU, which of the following best describes the role played by Intensivists in the ICU?

Always Attending of Record

Consultation Mandatory

Consultation Recommended for all patients

Consultation Only Upon Request of bedside attending

Consultation Not Available

AFTER implementation of tele-ICU, which of the following best describes role played by Intensivists in the ICU?

Always Attending of Record

Consultation Mandatory

Consultation Recommended for all patients

Consultation only upon request of bedside attending

Consultation Not Available

BEFORE implementation of tele-ICU, what percentage of the ICU Medical Director’s time was dedicated to ICU administration?
(Please indicate a percentage. If you are not sure, please give your best guess.)

FULL TIME – spends 100% of their time on ICU or tele-ICU patient care and administration (holds no other job responsibilities)

MOST OF THE TIME – spends 50%-99% of their time on ICU or tele-ICU patient care and administration

PART TIME – spends 15% to 49% of their time on ICU or tele-ICU patient care and administration

SOME TIME – spends less than 15% of their time on ICU or tele-ICU patient care and administration

No Medical Director

AFTER implementation of tele-ICU, what percentage of the ICU Medical Director’s time is dedicated to ICU administration?
(Please indicate a percentage. If you are not sure, please give your best guess.)

FULL TIME – spends 100% of their time on ICU or tele-ICU patient care and administration (holds no other job responsibilities)

MOST OF THE TIME – spends 50%-99% of their time on ICU or tele-ICU patient care and administration

PART TIME – spends 15% to 49% of their time on ICU or tele-ICU patient care and administration

SOME TIME – spends less than 15% of their time on ICU or tele-ICU patient care and administration

No Medical Director

BEFORE implementation of tele-ICU, which of the following best describes the ICU Committee or governance structure?

Highly Effective – interdisciplinary team that is accountable and incentivized for data-driven improvement in clinical outcomes, costs and staffing. Demonstrates integration of best practices and meets regularly

Moderately Effective – collaborative team with some accountability and moderate ability to demonstrate data-driven improvements.

Occasionally Effective – team representing most of the critical care involved disciplines which adopts common protocols and strategies but lacks accountability and collaboration efforts around process improvement.

Ineffective – Dysfunctional team without accountability, lack of common protocols and not inclusive of some or all disciplines and meets infrequently (less than once a month).

AFTER implementation of tele-ICU, which of the following best describes the ICU Committee or governance structure?

Moderately Effective – collaborative team with some accountability and moderate ability to demonstrate data-driven improvements.

Ineffective – Dysfunctional team without accountability, lack of common protocols and not inclusive of some or all disciplines and meets infrequently (less than once a month).

BEFORE implementation of tele-ICU, how often was documentation available that each case was reviewed by an Intensivist within 1 hour of admission?
(Please indicate a percentage. If you are not sure, please give your best guess.)

AFTER implementation of tele-ICU, how often is documentation available that each case is reviewed by an Intensivist within 1 hour of admission?
(Please indicate a percentage. If you are not sure, please give your best guess.)

BEFORE implementation of tele-ICU, how often were interdisciplinary rounds conducted on this unit?

Daily for every patient

Daily for some patients

Weekly for every patient

Weekly for some patients

Occasionally for every patient

Occasionally for some patients

Never

AFTER implementation of tele-ICU, how often are interdisciplinary rounds conducted on this unit?

Daily for every patient

Daily for some patients

Weekly for every patient

Weekly for some patients

Occasionally for every patient

Occasionally for some patients

Never

BEFORE implementation of tele-ICU, how often was ICU specific performance data reviewed with hospital leadership?

AFTER implementation of tele-ICU, how often is ICU specific performance data reviewed with hospital leadership?

BEFORE implementation of tele-ICU, what percentage of the time did the bedside provider team respond to alarms of potential physiological instability within three minutes?
(Please indicate a percentage. If you are not sure, please give your best guess.)

AFTER implementation of tele-ICU, what percentage of the time does the bedside provider team respond to alarms of potential physiological instability within three minutes?
(Please indicate a percentage. If you are not sure, please give your best guess.)

BEFORE implementation of tele-ICU, what percentage of the time did the ICU adhere to ICU best practices?
(Please indicate a percentage. If you are not sure, please give your best guess.)

AFTER implementation of tele-ICU, what percentage of the time does the ICU adhere to ICU best practices?
(Please indicate a percentage. If you are not sure, please give your best guess.)

For the following questions we are interested in learning about your experience AFTER implementation of the tele-ICU program.

Please select the phrase that best describes how bedside documentation is performed in this ICU.

All bedside physicians or billing providers, nursing staff, house staff, respiratory therapists, and other allied disciplines use electronic documentation that visible to the tele-ICU team.

More than one bedside discipline uses electronic documentation that is visible to the tele-ICU team.

One bedside discipline uses electronic documentation that is visible to the tele-ICU team.

Bedside providers document in a system that is NOT visible to the tele-ICU team.

Beside providers document in a system that is NOT visible to the tele-ICU team and do not access.

Please select the phrase that best describes your process for physician sign-out among your oncoming and outgoing tele-ICU staff.

All patients are reviewed with the bedside staff.

All cases thought to be unstable or active are reviewed in a structured format.

All cases thought to be unstable or active are reviewed in an unstructured format.

Left to discretion of tele-ICU providers.

Sign out not routinely performed.

Please select the phrase that best describes your process for sign-out from bedside providers to your tele-ICU staff after daily bedside rounds.

All patients have interactive sign-out.

More 50% providers and services have interactive sign-out.

Less then 50% of providers and services have interactive sign-out.

How is the tele-ICU documentation system integrated with the hospital information system?
(Please select all that apply.)

Laboratory values interface into ICU system.

Admission Discharge Transfer (ADT) information interfaces into the tele-ICU system.

Nursing flow sheet is available in tele-ICU system in real-time.

Medication orders interface to the tele-ICU system.

Respiratory therapy recorded ventilator data is available in the tele-ICU system.

Emergency Room care interfaces into the tele-ICU system.

Other

What percentage of physician progress notes are recorded in the tele-ICU documentation system or are available by real time electronic transfer into the tele-ICU system?
(Please indicate a percentage. If you are not sure, please give your best guess.)

What percentage of patient care documentation recorded by nursing staff, is done in the tele-ICU documentation system or is available by real time electronic transfer into the tele-ICU system?
(Please indicate a percentage. If you are not sure, please give your best guess.)

Was computer provider order entry (CPOE) introduced as part of your tele-ICU program?

Available before introduction of the tele-ICU intervention.

Introduced with the tele-ICU intervention.

Introduced after the tele-ICU intervention and during any post intervention data collection period.

Introduced after the tele-ICU intervention and after any post intervention data collection period.

Not used.

Please indicate which of the following bedside personnel are available on-site to respond to off-hour medical issues?

Physicians-in-training

Non-physician licensed providers

Emergency Department Physicians

Hospitalists

In-House Intensivists