Setting
This study will be performed in 12 hospitals with 15 ICUs serving ~ 3600 mechanically ventilated patients annually from Utah and Idaho in urban, suburban, and rural settings of Intermountain Health (Intermountain).Intermountain operates a mature tele-critical care program, with all study ICU rooms remotely monitored by a centralized tele-critical care hub using a shared electronic medical record, networked telemetry data, and equipment for two-way audiovisual communication between clinical personnel based at the tele-critical care hub and patients and bedside providers. The tele-critical care team — comprised of experienced ICU nurses, pharmacists, critical care physicians, advanced practice providers, and respiratory therapists — co-manages patients at seven community hospital ICUs and are available for consultation on patients located in eight referral center ICUs. Intermountain has a single electronic medical record for all inpatient care in study hospitals, so the tele-critical care providers have access to the same set of clinical information as bedside providers. Tele-critical care personnel have access to an electronic dashboard that displays ventilator mode, settings, and parameters and C-SAT/SBT status for every mechanically ventilated patient across the system. Real-time tele-critical care support is ideally suited to identify C-SAT/SBT candidates, motivate C-SAT/SBT performance, and provide bedside clinical teams with expert peer-to-peer consultation regarding how to perform C-SAT/SBT accurately and act on results.