Avera eCARE Research and Publications

Avera eCARE™ makes vital contributions to advancing the national research and literature on telemedicine services. We collaborate with institutions such as the University of Iowa, University of Pittsburgh and the University of North Dakota, among others.

You’ll find our medical professionals as primary authors and co-authors on key research studies, and our work is cited by diverse publications. Explore these peer-reviewed journal articles, abstracts and related sources to learn more about Avera eCARE’s contributions to important telemedicine topics.

eCARE ICU Publications

Factors Affecting Staff Perceptions of Tele-ICU Service in Rural Hospitals
Telemedicine and e-Health
Factors article at PubMed

ABSTRACT: Telemedicine is designed to increase access to specialist care, especially in settings distant from tertiary-care centers. One of the more established telemedicine applications in hospitals is the tele-intensive care unit (tele-ICU). Perceptions of tele-ICU users are not well studied. Thus, we undertook a study focused on assessing staff acceptance at multiple hospitals that had implemented a tele-ICU system.

Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System
Post Graduate Medicine

ABSTRACT: We evaluated the impact of a 15-hospital, rural, multi-state intensive care unit (ICU) telemedicine program. Acute Physiology, Age, and Chronic Health Evaluation (AP ACHE® III) scores, raw mortality rates, and actual-to-predicted length of stay (LOS) ratios and mortality ratios were used. Surveys evaluated program impact in smaller facilities and satisfaction of the physicians staffing the remote center. Smaller facilities' staff reported improvements in the quality of critical care services and reduced transfers. In regional hospitals, acuity scores increased (retention of sicker patients) while raw mortality was the same or lower. Length of stay ratios were reduced in these hospitals. In the tertiary hospital, actual-to-predicted ICU and hospital mortality and LOS ratios decreased.

Prognostic Outcomes After the Initiation of an Electronic Telemedicine Intensive Care Unit in a Rural Health System
South Dakota Medicine

ABSTRACT: APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.

Critical Care Telemedicine: Evolution and State of the Art 2014

OBJECTIVES: To review the growth and current penetration of ICU telemedicine programs, association with outcomes, studies of their impact on medical education, associations with medicolegal risks, identify program revenue sources and costs, regulatory aspects, and the ICU telemedicine research agenda.

CONCLUSIONS: The inclusion of an ICU telemedicine program as a major part of their critical care delivery paradigm has been implemented for 11 percent of critically ill U.S. adults as a solution for the problem of access to adult critical care services. Implementation of an ICU telemedicine program is one practical way to increase access and reduce mortality as well as length of stay. ICU telemedicine research including comparative effectiveness studies is urgently needed. (Crit Care Med 2014; 42:2429–2436)

A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care
DISCUSSION: The main finding of this study was that implementation of an ICU telemedicine program was associated with significantly lower mortality and shorter LOS in both the ICU and hospital setting. Significantly reduced hospital and ICU mortality and LOS were found in both crude analyses and analyses that were adjusted for potential confounding factors, including differences in acuity score, operative status, effects of time alone, and primary admission diagnosis. The association of the ICU telemedicine interventions with lower hospital mortality is notable because prior studies have not had adequate power to provide unequivocal evidence of this association. Notably, the reduction in LOS attributed to the ICU telemedicine intervention was most clinically meaningful among patients who stayed in the hospital or ICU for at least one week. The large size of the study and its finding that improvements in performance were not limited to a single type of ICU, size of hospital or community served, hospital teaching status, or US region suggests that these findings are broadly, rather than narrowly, applicable.

2013 NEHI TeleICU Report
ABSTRACT: Intensive care units (ICUs) are a vitally important component of health care in U.S. hospitals, treating 6 million of the sickest and oldest patients every year. The choices about how to manage ICUs carry high stakes: ICUs have both the highest mortality and the highest costs in health care, accounting for 4.1 percent of the nation’s $2.6 trillion in annual health care spending, or nearly $107 billion per year. Study findings include:

  1. Patient mortality decreased significantly.
  2. Patients’ stays in the ICU were shorter.
  3. Tele-ICUs have a rapid payback of investment for hospitals.
  4. Tele-ICUs have substantial financial benefit to payers.

Tele-ICU CCN 08-10 [PDF]
KEY POINTS: (1) The purpose of the tele-ICU is not to replace bedside clinicians or bedside care, but to provide improved safety and to enhance outcomes through standardization. (2) The tele-ICU is a “second set of eyes” that provides additional clinical surveillance and support. (3) Some eRNs are attracted to the tele-ICU to mitigate the significant physical and emotional demands of full-time bedside care. Others want to provide patient care in a new setting and enjoy being on the cutting edge of change.

eCARE Emergency Publications

Tele-emergency utilization: In what clinical situations is tele-emergency activated?
Journal of Telemedicine and Telecare
Tele-emergency article at PubMed
ABSTRACT: Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used. Analyses indicated that patients presenting at rural EDs with circulatory, injury, mental and symptoms diagnoses were significantly more likely to have tele-emergency department services activated as were patients who were transferred to another hospital. Interviews conducted with 85 clinicians and administrators at 26 rural hospitals that used this service indicated that this pattern of utilization facilitated rapid transfers and followed recommended clinical protocols for patients needing serious and/or urgent attention (e.g. stroke symptoms, chest pain).Although only used in 3.5 percent of ED encounters on average, our findings provide evidence that tele-emergency activation is well reasoned and related to those situations when extra expert assistance is particularly beneficial.

Effect of Tele-emergency Services on Recruitment and Retention of US Rural Physicians
Rural and Remote Health Journal
Effect article at PubMed
ABSTRACT: As competition for physicians intensifies in the USA, rural areas are at a disadvantage due to challenges unique to rural medical practice. Telemedicine improves access to care not otherwise available in rural settings. Previous studies have found that telemedicine also has positive effects on the work environment, suggesting that telemedicine may improve rural physician recruitment and retention, although few have specifically examined this.

Lessons From Tele-Emergency: Improving Care Quality And Health Outcomes By Expanding Support For Rural Care Systems
Health Affairs
Lessons article at PubMed
ABSTRACT: Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban “hub” emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all 71 hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with 90 clinicians and administrators at 29 of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base.