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Thank you for participating in this survey. Your feedback will help ACCP identify programmatic characteristics that are associated with outcomes of tele-ICU programs. This survey should take approximately 10 minutes to complete and your responses will remain completely confidential. |
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| Name of Health Care System: | | |
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What is the best descriptor of the critical care unit you are describing for this survey? |
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In what state is the hospital located? |
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Which of the following best describes the setting of your hospital? |
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What is the approximate population of the city where your hospital is located? |
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What is the teaching status of the hospital? |
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What is the teaching status of the ICU? |
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| How many hospitals with adult ICU’s are in your healthcare system? Please indicate a number. If you are not sure, please give your best guess. | | |
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| How many of the adult ICU units in your healthcare system are covered by the tele-ICU program? | | |
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| How many licensed beds are in this hospital? | | |
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| How many licensed beds are in this ICU? | | |
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| On what date did your tele-ICU program begin operation? | | |
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| How many of the licensed beds in the ICU are covered by the tele-ICU program? | | |
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| How many of those beds are NOT monitored by the tele-ICU support center? | | |
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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) |
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| On a typical weekday, how many hours is the tele-ICU support center staffed by an Intensivist? | | | | On a typical weekday, what is the largest number of tele-ICU Intensivists that work at the same time in your off-site monitoring center? | | | | On a typical weekday, what is the largest number of tele-ICU nurses, NPs, or PAs that work at the same time in your off-site monitoring center? | | |
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How much of the Medical Director’s time is dedicated to the administration of the tele-medicine program? |
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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.) |
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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.) |
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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.) |
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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.) |
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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.
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BEFORE implementation of tele-ICU, which of the following best describes the role played by Intensivists in the ICU?
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AFTER implementation of tele-ICU, which of the following best describes role played by Intensivists in the ICU? |
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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.) |
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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.) |
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BEFORE implementation of tele-ICU, which of the following best describes the ICU Committee or governance structure?
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AFTER implementation of tele-ICU, which of the following best describes the ICU Committee or governance structure? |
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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.) |
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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.) |
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BEFORE implementation of tele-ICU, how often were interdisciplinary rounds conducted on this unit? |
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AFTER implementation of tele-ICU, how often are interdisciplinary rounds conducted on this unit? |
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BEFORE implementation of tele-ICU, how often was ICU specific performance data reviewed with hospital leadership? |
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AFTER implementation of tele-ICU, how often is ICU specific performance data reviewed with hospital leadership? |
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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.) |
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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.) |
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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.) |
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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.) |
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For the following questions we are interested in learning about your experience AFTER implementation of the tele-ICU program.
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Please select the phrase that best describes how bedside documentation is performed in this ICU. |
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Please select the phrase that best describes your process for physician sign-out among your oncoming and outgoing tele-ICU staff. |
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Please select the phrase that best describes your process for sign-out from bedside providers to your tele-ICU staff after daily bedside rounds. |
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How is the tele-ICU documentation system integrated with the hospital information system? (Please select all that apply.) |
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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.) |
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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.) |
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Was computer provider order entry (CPOE) introduced as part of your tele-ICU program? |
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Please indicate which of the following bedside personnel are available on-site to respond to off-hour medical issues? |
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