Table 3 TIDieR (Template for Intervention Description and Replication) checklist [39]
From: Telemedicine with clinical decision support for critical care: a systematic review
Checklist | Lilly et al. (2011) | Lilly et al. (2014) |
|---|---|---|
Why: Describe the rationale, theory, or goal of the elements essential to the intervention | Rationale for introduction of telemedicine linked with:  1. Earlier recognition and appropriate response to physiological deterioration (safety and timeliness)  2. Implementation of evidence-based care (effectiveness)  The programme theory, i.e. how elements of the telemedicine were likely to bring about changes in outcomes not specified | Rationale for introduction of telemedicine linked with:  1. Shorter response to alarms and abnormal laboratory values  2. More rapid initiation of life-saving therapies  3. Higher rates of adherence to best practices The programme theory, i.e. how elements of the ICU telemedicine were likely to bring about changes in outcomes not specified |
What: Describe the materials and procedures used in delivery of the intervention | Telemedicine technical system included:  • Audio and video connectivity between bedside and remote team  • Access to medical record and laboratory and radiological studies  • Decision support software for detecting evolving physiologic instability, abnormal laboratory value alerts, review of response to alerts  • Screening tools to help process of weaning in mechanically ventilated patients  • Nurse manager rounding tool to track glycaemic control, prevention of venous thrombosis, cardiovascular complications, catheter-related bloodstream infection, ventilator-associated pneumonia, and stress ulcers  • Adherence to best practice guidelines in real time Role of the off-site team  • Serial review of individual patients, audits of best practice adherence, monitoring system-generated electronic alerts, and auditing bedside clinician responses to in-room alarms  • Communicate with bedside clinicians or directly manage patients by recording clinician orders for tests, treatments, consultations, and management of life-support devices  • Intervene when bedside clinicians’ response was delayed and patients were deemed physiologically unstable  • Management of out-of-hours cases: review and assignment of case to an appropriate ICU team, patient assessment using real-time video, response to alerts and alarms, review response to the initial plan of care in real time, shared responsibility for altering the care plan if the patient’s condition fails to respond  • Monitoring steps taken to remediate non-adherence and deficiencies related to inadequate documentation | Unclear how many sites already had electronic record system in place prior to the start of the programme. Telemedicine technical system provided by Koninklijke Philips N.V. (previously Philips VISICU) which included:  • Audio and video connections between bedside and remote team, and electronic medical record  • Decision support software for detecting evolving physiologic instability  • Additional off-site team to support bedside personnel Availability of bedside documentation to the off-site team, rounding tools, and performance management varied across sites. Role of the off-site team  • Serial review of individual patients, audits of best practice adherence, monitoring system-generated electronic alerts, and auditing bedside clinician responses to in-room alarms Admission, review, and intervention responsibilities varied across sites. |
Who: Describe the providers of the intervention | Off-site cover  Hospital staff intensivist, an ICU affiliate practitioner, a systems analyst, and one or more data clerks Integration of bedside and off-site staff  • Clinical staff from the support centre also worked in the medical centre adult ICUs. | Off-site cover Intensivist available between 12 and 24 h a day, nurse available 24/7 (personal correspondence)  Staffing numbers in support centre during weekdays  • Intensivists 1–3  • Nurses/nurse practitioners/physician assistants 1–12 Medical director’s time dedicated to the telemedicine programme and levels of technical support provided to the programme varied across sites. ICU bedside staffing model Intensivists’ cover in ICU, medical cover out-of-hours and ICU medical director time dedicated to patient care and administration varied across sites. Integration of bedside and off-site staff Some staff from the support centre also worked at the bedside. |
Where: location where the intervention took place | Off-site support centre | Not reported |
When and how much: Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity, or dose |  • Off-site clinicians reviewed care plans for 48 % of after-hours admissions (46 % reviewed by other methods in the control period)  • Total no. of alerts for physiological instability per patient per day was 6.80. Of these, 5.05 alerts were managed by bedside clinicians without telemedicine intervention and 1.75 alerts were managed with telemedicine intervention. Most interventions were initiated by the telemedicine team.  • Among 24,426 interventions that affected the diagnostic or therapeutic plan, 23,943 were initiated by off-site clinicians and 483 interventions were initiated by bedside clinicians (ratio of 50:1). Among these interventions, 1633 were documented with progress notes that included a rating of the severity of the physiological disturbance; 76 % of these were classified as major (e.g. requiring initiation of a vasoactive medication). | Not reported |
Tailoring or modifications: If the intervention was planned to be personalised, or was adapted during the course of the study, then describe what, why, when, and how. | Not reported | Not reported |
How well: assessment of the intervention adherence or fidelity and description of any strategies used to maintain or improve fidelity | Not reported | Not reported |