| Title |
Telemedicine with clinical decision support for critical care: a systematic review
|
|---|---|
| Published in |
Systematic Reviews, October 2016
|
| DOI | 10.1186/s13643-016-0357-7 |
| Pubmed ID | |
| Authors |
Nicola Mackintosh, Marius Terblanche, Ritesh Maharaj, Andreas Xyrichis, Karen Franklin, Jamie Keddie, Emily Larkins, Anna Maslen, James Skinner, Samuel Newman, Joana Hiew De Sousa Magalhaes, Jane Sandall |
| Abstract |
Telemedicine applications aim to address variance in clinical outcomes and increase access to specialist expertise. Despite widespread implementation, there is little robust evidence about cost-effectiveness, clinical benefits, and impact on quality and safety of critical care telemedicine. The primary objective was to determine the impact of critical care telemedicine (with clinical decision support available 24/7) on intensive care unit (ICU) and hospital mortality and length of stay in adults and children. The secondary objectives included staff and patient experience, costs, protocol adherence, and adverse events. Data sources included MEDLINE, EMBASE, CINAHL, Cochrane Library databases, Health Technology Assessment Database, Web of Science, OpenGrey, OpenDOAR, and the HMIC through to December 2015. Randomised controlled trials and quasi-experimental studies were eligible for inclusion. Eligible studies reported on differences between groups using the telemedicine intervention and standard care. Two review authors screened abstracts and assessed potentially eligible studies using Cochrane guidance. Two controlled before-after studies met the inclusion criteria. Both were assessed as high risk of bias. Meta-analysis was not possible as we were unable to disaggregate data between the two studies. One study used a non-randomised stepped-wedge design in seven ICUs. Hospital mortality was the primary outcome which showed a reduction from 13.6 % (CI, 11.9-15.4 %) to 11.8 % (CI, 10.9-12.8 %) during the intervention period with an adjusted odds ratio (OR) of 0.40 (95 % CI, 0.31-0.52; p = .005). The second study used a non-randomised, unblinded, pre-/post-assessment of telemedicine interventions in 56 adult ICUs. Hospital mortality (primary outcome) reduced from 11 to 10 % (adjusted hazard ratio (HR) = 0.84; CI, 0.78-0.89; p = <.001). This review highlights the poor methodological quality of most studies investigating critical care telemedicine. The results of the two included studies showed a reduction in hospital mortality in patients receiving the intervention. Further multi-site randomised controlled trials or quasi-experimental studies with accompanying process evaluations are urgently needed to determine effectiveness, implementation, and associated costs. PROSPERO CRD42014007406. |
X Demographics
The data shown below were collected from the profiles of 9 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 4 | 44% |
| India | 1 | 11% |
| United States | 1 | 11% |
| Unknown | 3 | 33% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 6 | 67% |
| Practitioners (doctors, other healthcare professionals) | 3 | 33% |
Mendeley readers
The data shown below were compiled from readership statistics for 195 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | <1% |
| Unknown | 194 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 33 | 17% |
| Student > Ph. D. Student | 28 | 14% |
| Other | 17 | 9% |
| Student > Doctoral Student | 17 | 9% |
| Researcher | 16 | 8% |
| Other | 42 | 22% |
| Unknown | 42 | 22% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 61 | 31% |
| Nursing and Health Professions | 37 | 19% |
| Social Sciences | 7 | 4% |
| Business, Management and Accounting | 6 | 3% |
| Computer Science | 6 | 3% |
| Other | 31 | 16% |
| Unknown | 47 | 24% |
Attention Score in Context
This research output has an Altmetric Attention Score of 10. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 December 2020.
All research outputs
#3,543,259
of 24,671,780 outputs
Outputs from Systematic Reviews
#659
of 2,153 outputs
Outputs of similar age
#58,649
of 322,549 outputs
Outputs of similar age from Systematic Reviews
#17
of 46 outputs
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