远程多中心重症监护网络的临床应用

The clinical application of remote critical care network

目的评价应用远程多中心重症监护网络是否能提高入网医院重症监护病房（ICU）危重患者的抢救效率和经济效益。方法建立医院重症监护专业医师和多科专家组成的会诊中心，通过会诊中心和远程ICU均配备相应的软件平台来实现电子数据的传输、显示和影音交流，对危重病患者进行远程会诊指导。在项目实行后，对入网满1年的医院进行医疗和经济效益评价，并与入网前1年的结果进行比较。结果至2009年7月止，浙江省共有63家医院加入远程多中心重症监护网络，有1617例重症监护患者接受了远程会诊，同时进行了173次远程教学查房和72次远程授课。对其中23家入网时间满1年的医院进行了前后数据的比较，结果显示，ICU的平均病死率下降了11．6％（12．9％比14．6％），危重患者转院率下降了38．3％（2．9％比4．7％），ICU床位利用率提高了6．1％（83．4％比78．6％）。结论远程重症监护项目的实施可以改善患者的临床预后，提高医院经济效益。

Objective To discuss and evaluate whether a remote critical care program network can improve clinical and economic performance across multiple intensive care units （ICUs）. Methods The consultative center composed of intensivists and physician extenders to provide remote consultations for the critical patients. Supporting software, including electronic data display and communication interface were available both in the ICU center and at the remote sites. Clinical and economic performance after 1 year application of the program was compared with the performance before the intervention. Results During January 2008 to July 2009, there had been 63 hospitals in Zhejiang Province joined the network. A total of 1 617 patients had received remote critical care consultations. One hundred and seventy-three remote teaching ward rounds and 72 lectures had been conducted on the network during this period. The before- and after- data comparison for 23 hospitals which had joined the network for longer than 1 year showed that, the program had decreased ICUs raw mortality by 11.6% （12. 9% vs. 14. 6%）, and reduced transfer rate by 38.3% （2.9% vs. 4.7%）, and ICUs bed occupancy rate increased by 6.1% （83.4% vs. 78.6%）. Conclusion The application of a remote critical care program was associated with improved clinical outcomes of critically ill patients and hospital financial performance.