Comparison of Tele-Critical Care Versus Usual Care On ICU Performance (TELESCOPE)

Comparison of Tele-Critical Care Versus Usual Care On ICU Performance: A Cluster Randomized Clinical Trial

TELESCOPE will be a cluster randomized clinical trial to ascertain whether the use of an intervention including multidisciplinary round with a board certified physician through tele-critical care and periodic meetings to discuss strategies to improve quality indicators can reduce ICU length of stay of patients admitted to intensive care units (ICUs).

Cluster randomized trial involving ICUs in Brazil. ICU is the unit of randomization.

The trial will have two stages:

Stage I - Baseline data:

• Characterize participant ICUs and quality indicators
• Characterize patients from each participant ICU to describe baseline outcomes

Stage II - Intervention:

This is the main stage for data analysis. ICUs will be randomly assigned to an experimental or control group. The experimental group should use a multidisciplinary rounds with a board certified physician through tele-critical care and take part in meetings to discuss how to improve local quality indicators, and the control group will follow the local standard of care.

Inclusion Criteria for Clusters:

• Intensive care units from public hospitals and with at least eight beds
• Intensive care units with physician and nurses available 24 hours a day

Exclusion Criteria for Clusters:

• Intensive care units with structured multidisciplinary round more than three times a week based in a formal instrument
• Intensive care units already doing audit & feedback
• Dedicated coronary care units/cardiac intensive care units or other specialized units
• Step-down units

Inclusion Criteria for Patients:

• Adult patients (> 18 years old)
• Admitted after the beginning of the study

Exclusion Criteria for Patients:

• Admission for other reasons than medical (e.g., judicial cause)
• Previously included in TELESCOPE (for the primary outcome analysis)