CHEST Guidelines-Response_chest

Response_chest_22 (3)

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The document includes two letters and a response to the Editor of the journal CHEST, discussing research findings on ICU telemedicine and a simulation-based educational intervention.<br /><br />The first letter from Dr. Stephanie Parks Taylor and Dr. Brice Taylor comments on a study by Fortis et al. that suggested ICU telemedicine reduced interhospital transfers but increased mortality in transferred patients. Taylor and Taylor suggest that this may reflect appropriate triage rather than a direct consequence of telemedicine. They argue that the primary goal of interhospital transfers should be to improve patient outcomes, not simply serve those most severely ill, emphasizing the value of avoiding futile transfers which burden both the healthcare system and the patients' families. They also inquire if further data could shed light on whether telemedicine supports futile transfers by analyzing transitions to comfort-focused care.<br /><br />In response, Fortis and colleagues acknowledge the observation on increased mortality, attributing it to the likelihood that telemedicine helps in triaging less severe patients, leaving the sickest for transfer. They support the notion that transferring only patients who could benefit from advanced care is critical, while recognizing the complexity surrounding desperate transfer requests. Although additional data on futile transfers isn't available, they cite evidence that palliative care can be effectively delivered via telemedicine to mitigate unnecessary transfers.<br /><br />Additionally, the document includes a separate letter discussing an educational experiment using a respiratory patient simulator for training internal medicine residents on noninvasive ventilation use. The study found that while post-exercise test scores improved in both simulation and traditional group settings, no significant long-term knowledge retention differences were observed, contrary to expectations that simulations enhance medical education. The findings suggest methodological factors may have minimized biases in favor of simulation.

Keywords

ICU telemedicine

interhospital transfers

mortality

triage

futile transfers

palliative care

simulation-based education

noninvasive ventilation

medical education

knowledge retention