The Use Of Tele-medicine In Home/Community/Rehabilitation Intensive Care Unit

ObjectiveSome patients stay too long in ICU, which bring not only heavy financial burden to family but also bad influences on ICU department. Some scholars suggest establishing home/community/rehabilitation ICU for these patients in which telemedicine system will be equipped to monitor the patients. However there are still burdens. Such as:①Some people are worried about the safety and feasibility of the patients after leaving hospital ICU;②The One-time investment cost too much;③Some medical doctor and relatives of patient thinks that there is no need to establish the home/community/rehabilitation ICU;④The telemedicine system can’t meet the needs of home/community/rehabilitation ICU well.Retrospective case review is used to discuss:①the necessity to establish home/community/rehabilitation ICU,②the economical efficiency to establish home/community/rehabilitation ICU,③benefits to establish home/community/rehabilitation ICU and④the essential function of the telemedicine system.Methods:1. Object: Collect relevant data of patients from Jun2013to Dec2013hospitalized in the critical care unit of Eastern Hospital of Shandong Provincial Hospital. During that time,65patients whose lengths of stay (LOS) in hospital ICU were above10days were selected in this research.2. Research Approaches2.1Discuss the safety and feasibility by the life-supporting method and possible emergency measures needed by the patients.2.2Based on the result of2.1, calculate the one-time and daily cost of home/community/rehabilitation ICU. Compare with the daily cost in hospital ICU to discuss the economical efficiency.2.3Discuss the good influence by home/community/rehabilitation ICU in controlling cross infection by collecting the etiological examination condition of the long-stay patients.2.4Based on the result of2.1, discuss the essential function of the telemedicine system.2.5Based on the result of2.1,2.2and2.3, discuss the benefits of establishing home/community/rehabilitation ICU3. Statistical Methods: Data are presented as mean±standard deviation (x±s); Use SAS9.1software for statistical analyzing. P<0.05represent for significant difference. T test for Normal distribution and homogeneity of variance; counting data use chi-square test; non-normal distribution use rank test.Result:1. Safety and feasibility of home/community/rehabilitation ICU.Some methods can be accomplished in home/community/rehabilitation ICU by caretaker after some simple training, such as bedridden patients care, nutrition supply etc.Some methods can be accomplished in home/community/rehabilitation ICU by caretaker with assisting by experts, such as patient-monitoring, mechanical ventilation etc.Some methods cannot be accomplished in home/community/rehabilitation ICU, such as blood purification airway obstruction etc.Thus, the safety and feasibility of home/community/rehabilitation ICU can be insured after a evaluation of patients.2. Economical efficiencyThe current cost of all groups is lower than the average daily cost in the first10days.3. Control Cross InfectionAmong of bacterial species is positively correlated with the length of Staying time in hospital ICU.The occur of Hospital-acquired infection is positively correlated with the length of Staying time in hospital ICU.The group LOS10-29has a lower number of drug-resistance bacteria infection and colonization than the total of group LOS30～59and LOS above60.(P=0.071)The cost of the patients not infected or colonizated by drug-resistance bacteria is lower than those of infected or colonizated (p=0.324)The LOS of the patients not infected or colonizated by bacteria or only by sensitive bacteria is lower than those infected or colonizated by drug-resistance bacteria.(P1=0.2039, P2=0.5660) As a word, there is more chance to lead to cross infection as patients staying longer in hospital ICU4. The essential function of the telemedicine systemTele-medicine system are needed to transmit monitoring information, double communication, remote control on ventilator and remote courses.Conclusion:1. the safety and feasibility of home/community/rehabilitation ICU can be insured but only after a evaluation of patients:①After a30days of stay in hospital ICU;②No need for Blood purification;③No need for blood gas/electrolytes monitoring or live very near to clinical laboratory.④No need for trachea cannula or have been changed to trachea incision.⑤The caretakers have master the essential treating methods;⑥The agreement of its responsible physician.2. It is better in the economical efficiency that the hospital ICU department and the control of infection for some patients to enter home/community/rehabilitation ICU than staying in hospital ICU.3. The function of tele-medicine system that were needed contains:1. Remote monitoring;2.both-way communication;3. Connecting with ventilator;4. Remote education.4. There are benefits of establishing home/community/rehabilitation ICU than staying long-time in hospital ICU.