Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial

  1. Spies, Claudia ORCID logo
  2. Paul, Nicolas ORCID logo
  3. Adrion, Christine ORCID logo
  4. Berger, Elke ORCID logo
  5. Busse, Reinhard ORCID logo
  6. Kraufmann, Ben
  7. Marschall, Ursula
  8. Rosseau, Simone
  9. Denke, Claudia ORCID logo
  10. Krampe, Henning ORCID logo
  11. Dähnert, Enrico ORCID logo
  12. Mansmann, Ulrich ORCID logo
  13. Weiss, Björn ORCID logo
  14. Adam, Moritz F.
  15. Albers, Lucas
  16. Andrees, Nicolai
  17. Angermair, Stefan
  18. Balzer, Felix
  19. Bartsch, Sascha
  20. Becherer, Sabine
  21. Boie, Sebastian
  22. Braun, Jan-Peter
  23. Busch, Felix
  24. Büyüközer, Askin
  25. Caumanns, Jörg
  26. Cittadino, Jonas
  27. Düllmann, Eva M.
  28. Edel, Andreas
  29. Eymold, Lisa
  30. Franke, Cynthia S.
  31. Fritz, Georg
  32. Gaßner, Martina
  33. Geissler, Alexander
  34. Goedecke, Maximilian
  35. Görtzen, Susanne
  36. Grunow, Julius
  37. Hartung, Edmund
  38. Heidemann, Stefan
  39. Hennig, Beata
  40. Herm, Julian
  41. Heymann, Anja
  42. Höft, Moritz
  43. Janke, Jürgen
  44. Janssen, Hans-Joachim
  45. Kastrup, Marc
  46. Kibat, Thomas
  47. Kirsten, Sascha
  48. Kleinwächter, Robin
  49. Klink, Wilma
  50. Klöpper, Tobias
  51. Knauthe, Anna-C.
  52. König, Jens-Peter
  53. König, Thomas
  54. Krautz, Max R.
  55. Landgraf, Philipp
  56. Loock, Carola
  57. Lorenz, Ralf
  58. Melnikov, Alexandr
  59. Memmert, Belinda
  60. Menk, Mario
  61. Moormann, Tobias
  62. Nibbe, Lutz
  63. Niemetz, Stephan
  64. Ocken, Michele
  65. Oppert, Michael
  66. Pigorsch, Mareen
  67. Pille, Christian
  68. Pobering, Ivo
  69. Puhlmann, Birgit
  70. Rahmel, Melanie
  71. Reyle-Hahn, Stephan-Matthias
  72. Buse, Elena L. Ribet
  73. Röber, Susanne
  74. Rohde, Steffen
  75. Röhrs, Arne
  76. Rosenthal, Max
  77. Ro��berg, Kerstin
  78. Rumschüßel, Kay
  79. Sander, Ulf
  80. Sanft, Carsten
  81. Schmidt, Maren
  82. Schmidt, Maximilian
  83. Schmidt, Sebastian
  84. Schmittner, Marc
  85. Schön, Julika
  86. Schröder, Torsten
  87. Staerck, Franziska
  88. Steinecke, Karin
  89. Tafelski, Sascha
  90. Treskatsch, Sascha
  91. Vogler, Marlies
  92. Weber-Carstens, Steffen
  93. Weiland, Dirk
  94. Wojcik, Renata

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WeightNameValue
1000 Titel
  • Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial
1000 Autor/in
  1. Spies, Claudia |
  2. Paul, Nicolas |
  3. Adrion, Christine |
  4. Berger, Elke |
  5. Busse, Reinhard |
  6. Kraufmann, Ben |
  7. Marschall, Ursula |
  8. Rosseau, Simone |
  9. Denke, Claudia |
  10. Krampe, Henning |
  11. Dähnert, Enrico |
  12. Mansmann, Ulrich |
  13. Weiss, Björn |
  14. Adam, Moritz F. |
  15. Albers, Lucas |
  16. Andrees, Nicolai |
  17. Angermair, Stefan |
  18. Balzer, Felix |
  19. Bartsch, Sascha |
  20. Becherer, Sabine |
  21. Boie, Sebastian |
  22. Braun, Jan-Peter |
  23. Busch, Felix |
  24. Büyüközer, Askin |
  25. Caumanns, Jörg |
  26. Cittadino, Jonas |
  27. Düllmann, Eva M. |
  28. Edel, Andreas |
  29. Eymold, Lisa |
  30. Franke, Cynthia S. |
  31. Fritz, Georg |
  32. Gaßner, Martina |
  33. Geissler, Alexander |
  34. Goedecke, Maximilian |
  35. Görtzen, Susanne |
  36. Grunow, Julius |
  37. Hartung, Edmund |
  38. Heidemann, Stefan |
  39. Hennig, Beata |
  40. Herm, Julian |
  41. Heymann, Anja |
  42. Höft, Moritz |
  43. Janke, Jürgen |
  44. Janssen, Hans-Joachim |
  45. Kastrup, Marc |
  46. Kibat, Thomas |
  47. Kirsten, Sascha |
  48. Kleinwächter, Robin |
  49. Klink, Wilma |
  50. Klöpper, Tobias |
  51. Knauthe, Anna-C. |
  52. König, Jens-Peter |
  53. König, Thomas |
  54. Krautz, Max R. |
  55. Landgraf, Philipp |
  56. Loock, Carola |
  57. Lorenz, Ralf |
  58. Melnikov, Alexandr |
  59. Memmert, Belinda |
  60. Menk, Mario |
  61. Moormann, Tobias |
  62. Nibbe, Lutz |
  63. Niemetz, Stephan |
  64. Ocken, Michele |
  65. Oppert, Michael |
  66. Pigorsch, Mareen |
  67. Pille, Christian |
  68. Pobering, Ivo |
  69. Puhlmann, Birgit |
  70. Rahmel, Melanie |
  71. Reyle-Hahn, Stephan-Matthias |
  72. Buse, Elena L. Ribet |
  73. Röber, Susanne |
  74. Rohde, Steffen |
  75. Röhrs, Arne |
  76. Rosenthal, Max |
  77. Ro��berg, Kerstin |
  78. Rumschüßel, Kay |
  79. Sander, Ulf |
  80. Sanft, Carsten |
  81. Schmidt, Maren |
  82. Schmidt, Maximilian |
  83. Schmidt, Sebastian |
  84. Schmittner, Marc |
  85. Schön, Julika |
  86. Schröder, Torsten |
  87. Staerck, Franziska |
  88. Steinecke, Karin |
  89. Tafelski, Sascha |
  90. Treskatsch, Sascha |
  91. Vogler, Marlies |
  92. Weber-Carstens, Steffen |
  93. Weiland, Dirk |
  94. Wojcik, Renata |
1000 Verlag
  • Springer Berlin Heidelberg
1000 Erscheinungsjahr 2023
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2023-01-16
1000 Erschienen in
1000 Quellenangabe
  • 49(2):191-204
1000 Copyrightjahr
  • 2023
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1007/s00134-022-06949-x |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9841931/ |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • Purpose!#!Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (ICUs) in Germany.!##!Methods!#!We conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with an expected ICU stay of ≥ 24 h. Twelve ICU clusters in Berlin and Brandenburg were randomly assigned to three sequence groups to transition from control (standard care) to the intervention condition (telemedicine). The quality improvement intervention consisted of daily telemedical rounds guided by eight German acute ICU care QIs and expert consultations. Co-primary effectiveness outcomes were patient-specific daily adherence (fulfilled yes/no) to QIs, assessed by a central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. This study is completed and registered with ClinicalTrials.gov (NCT03671447).!##!Results!#!Between September 4, 2018, and March 31, 2020, 1463 patients (414 treated on control, 1049 on intervention condition) were enrolled at ten clusters, resulting in 14,783 evaluated days. Two randomised clusters recruited no patients (one withdrew informed consent; one dropped out). The intervention, as implemented, significantly increased QI performance for 'sedation, analgesia and delirium' (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395-8.358), 'ventilation' (OR 2.248, 1.198-4.217), 'weaning from ventilation' (OR 9.049, 2.707-30.247), 'infection management' (OR 4.397, 1.482-13.037), 'enteral nutrition' (OR 1.579, 1.032-2.416), 'patient and family communication' (OR 6.787, 3.976-11.589), and 'early mobilisation' (OR 3.161, 2.160-4.624). No evidence for a difference in adherence to 'daily multi-professional and interdisciplinary clinical visits' between both conditions was found (OR 1.606, 0.780-3.309). Temporal trends related and unrelated to the intervention were detected. 149 patients died during their index ICU stay (45 treated on control, 104 on intervention condition).!##!Conclusion!#!A telemedical quality improvement program increased adherence to seven evidence-based German performance indicators in acute ICU care. These results need further confirmation in a broader setting of regional, non-academic community hospitals and other healthcare systems.
1000 Sacherschließung
lokal Quality of care
lokal Telemedicine [MeSH]
lokal Critical care
lokal Comparative effectiveness
lokal Implementation
lokal Adult [MeSH]
lokal Humans [MeSH]
lokal Stepped wedged cluster randomised controlled trial
lokal Critical illness
lokal Original
lokal Critical Care/methods [MeSH]
lokal Respiration [MeSH]
lokal Medical and Health Sciences
lokal Telemedicine
lokal Intensive Care Units [MeSH]
lokal Healthcare quality indicators
lokal Quality improvement
lokal Guideline adherence
lokal Lung [MeSH]
1000 Liste der Beteiligten
  1. 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