Staff Acceptance of Tele-ICU Coverage

Abstract

A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced length of stay, 1 only one-third of critically ill patients receive intensivist care, and the shortfall is projected to worsen. 2 As a result, hospitals increasingly rely on tele-ICU coverage. 3 For the purposes of this article, we defi ne tele-ICU coverage as the application of telemedicine 4 to in-hospital critical care units, thereby encompassing an array of technologies of varying complexity 5,6 that allow physical ICUs to access critical care experts in real time.At the present time, it is estimated that 10% of US hospitals use some form of tele-ICU coverage, Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU confi guration, methodology, participants, and fi ndings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by . 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.

Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit

“…For example, McCambridge et al [17] characterized the tele-ICU as one component of a coordinated health care information technology bundle. The governance structure of ICU care within the University of Massachusetts-Memorial health care system was restructured and centralized before a tele-ICU implementation [3]. In our work, we limited changes within the ICU to 2-way audiovisual communication and tele-ICU staffing.…”

“…Telemedicine is a complex sociotechnical intervention, and the context regarding how it is implemented and supported and the type of organizations in which it is used may influence its impact Young et al [3]. We chose to use a consultative care model so that it could be uniformly applied to all patients in the test ICU.…”

“…Highly staffed models of intensivist provider coverage are associated with lower ICU and hospital mortality as well as reduced ICU and hospital length of stay, but staffing in the United States is limited by the number of available physicians [2,3]. Currently, only approximately 1 quarter of intensive care units (ICUs) are considered to be highly staffed, meaning more than 80% of the patients are managed by a full-time or consulting intensivist [2,4,5].…”

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine

“…Unfortunately, providers such as intensivists have been decreasing in numbers, causing a shortage of care practitioners. 10 According to a 2006 Health Resources and Services Administration study, the United States will need as many as 4,300 critical care physicians by 2020, and a 1,500 intensivist shortfall is predicted. 11,12 Physicians trained as intensivists who provide care via tele-ICU have been able to help fill this gap in order to deliver more effective healthcare.…”

“…13 It has been suggested that tele-ICU implementation and utilization have the potential to be as effective as having dedicated intensivists in the ICU 24 h/day, relieving taxed staff, and providing quality care to the ever-increasing ICU patient population. 10 The purpose of this study was to determine the potential impact and direction of the implementation of the tele-ICU in hospitals to assess current benefits and barriers of adoption of this technology.…”