Figure 1
Location of El Centro Regional Medical Center (El Centro, CA), Tijuana General Hospital (Tijuana, MX), and Mexicali General Hospital (Mexicali, MX), in relation to US-Mexico border and UCSDHS, located in San Diego, CA [29].
Table 1
Description of Tele-ICU intervention at each border hospital site. HGM, Mexicali General Hospital (Mexicali, MX); HGT, Tijuana General Hospital (Tijuana, MX); ECRMC, El Centro Regional Medical Center (El Centro, CA, USA). RN = Registered Nurse; RT = Respiratory Therapist
| TYPE OF TELE-ICU INTERVENTION | HGM | HGT | ECRMC |
|---|---|---|---|
| Direct management (order-writing, note-writing, care plan review with RNs, RTs, hospitalists, etc.) | ✓ | ||
| Consultative/educational (individual case presentation and discussion of active patients, with specific recommendations given to bedside providers only) and/or review of relevant journal articles on severe COVID-19 patient management | ✓ | ✓ | Only upon request by bedside providers (occurred approximately once per month) |
Table 2
Frequency of interventions by the Tele-ICU service to achieve evidence-based standard of care in the management of critical care patients at ECRMC. More than one intervention within each category was seen in some cases
| INTERVENTION | INTERVENTIONS MADE TO ACHIEVE STANDARD OF CARE (% OF TOTAL ENCOUNTERS) | |||
|---|---|---|---|---|
| APRIL 2020 | MAY 2020 | JUNE 2020 | JULY 2020 | |
| Prone positioning | 0 | 57 | 30 | 57 |
| (0%) | (46%) | (20%) | (30%) | |
| Advanced ventilator management | 18 | 75 | 194 | 211 |
| (38%) | (60%) | (134%) | (112%) | |
| Hemodynamic management | 2 | 20 | 50 | 50 |
| (4%) | (16%) | (34%) | (27%) | |
| Fluid management | 1 | 70 | 90 | 121 |
| (2%) | (56%) | (63%) | (64%) | |
| Sedation/neuromuscular antagonist management | 12 | 55 | 88 | 100 |
| (25%) | (44%) | (61%) | (53%) | |
| Nutrition and bowel motility | 0 | 6 | 90 | 79 |
| (0%) | (5%) | (63%) | (42%) | |
| Venous thromboembolism prophylaxis | 0 | 0 | 32 | 12 |
| (0%) | (0%) | (22%) | (6%) | |
| Stress ulcer prophylaxis | 0 | 0 | 28 | 21 |
| (0%) | (0%) | (19%) | (11%) | |
Figure 2
Percentage of ICU patients perceived to be receiving evidence-based care at ECRMC by respiratory therapy, nursing, and physician staff at ECRMC, as a result of Tele-ICU adoption. Before Tele-ICU refers to prior to April 6, 2020. Survey conducted on June 28, 2020.
Figure 3
Change in confidence level of 7 physicians, 10 respiratory therapists, 10 nurses at ECRMC, as a result of Tele-ICU adoption. Note that confidence levels increased even in the care of patients without COVID-19 illness, who almost never were seen by Tele-ICU service, indicating a cross-over effect.