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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
19,360
Daily multidisciplinary rounds with a board certified physician through tele-critical care focusing on: 1) diagnosis; 2) active problems; and 3) therapeutic goals. In addition, the management of health care quality indicators will be conducted by a specially trained (Science of Improvement) board-certified intensive care physician.
Hospital Israelita Albert Einstein
São Paulo, Brazil
Intensive Care Unit Length of Stay
Time until discharge from the intensive care unit
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
In-Hospital Mortality
Any death during hospital stay
Time frame: From date of randomization until the date of hospital discharge or death, whichever comes first, assessed up to 90 days
Standardized Resource Use
Calculated based on length of stay in the intensive care unit and adjusted for severity of acute illness
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Standardized Mortality Rate
Ratio of observed deaths to expected deaths
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Incidence Density of Central Line-Associated Bloodstream Infection (CLABSI)
Following the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) Surveillance Definition of Healthcare-Associated Infection 2019
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Incidence Density of Ventilator-Associated Pneumonia (VAP)
Following the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) Surveillance Definition of Healthcare-Associated Infection 2019
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
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Incidence Density of Urinary Tract Infection Associated with Catheter
Following the Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) Surveillance Definition of Healthcare-Associated Infection 2019
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Ventilator-Free Days at Day 28
Survival time free of invasive mechanical ventilation from ICU admission to day 28.
Time frame: 28 Days
Patient-Days Receiving Oral or Enteral Feeding
Use of enteral or oral feeding
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Patient-Days Under Light Sedation or Alert and Calm
Defined as a Richmond Agitation-Sedation Scale (RASS) -3 to +1
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days
Rate of Patients Under Normoxia
Defined as oxygen saturation (SpO2) between 92% and 96%
Time frame: From date of randomization until the date of ICU discharge or death, whichever comes first, assessed up to 90 days