Elsevier

Journal of Critical Care

Volume 28, Issue 3, June 2013, Pages 315.e1-315.e12
Journal of Critical Care

Contributions of tele–intensive care unit (Tele-ICU) technology to quality of care and patient safety,☆☆

https://doi.org/10.1016/j.jcrc.2012.10.005Get rights and content

Abstract

The deployment of remote monitoring of intensive care unit (ICU) patients, known as tele-ICU technology, promotes the efficient use of critical care resources. Although tele-ICU use has spread rapidly, the benefits vary widely among studies, and little is known about the specific characteristics of tele-ICU that provide benefits to patient care. The purpose of this study was to identify aspects of tele-ICU that contribute, whether positively or negatively, to care processes and patient outcomes. This study was not aimed at evaluating the impact of tele-ICU on care outcomes.

We conducted a qualitative study using semistructured interviews. Sixty-one tele-ICU staff from 5 tele-ICUs participated in the study. We performed inductive content analysis and coded 722 pieces of text into 19 positive and 9 negative/neutral tele-ICU contributions to care processes and patient outcomes. We found that availability of extra resources can reduce on mortality and length of stay, that a tele-ICU could serve as a quality trigger to improve evidence-based medicine compliance, that tele-ICU can support medication management and improve medication safety, and that tele-ICU software alerts and monitoring by camera can help reduce the risk of patient falls and extubations. We also found that tele-ICU physicians can make poor care decisions leading to medication errors if they lack patient-related information. Moreover, the tele-ICU has no impact on patient care processes and outcomes when the technology is not accepted and used by ICU staff.

Section snippets

Purpose

Tele-Intensive Care Unit (Tele-ICU) is a remote monitoring technology that promotes the efficient deployment of intensivists and other critical care resources [1], [2]. This technology can provide intensive care units (ICUs) with 24/7 access to intensivists and critical care nurses [2], [3] and help ICUs meet the Leapfrog Group's ICU Physician Staffing standard [4]. The Leapfrog Group suggests that quality of care in ICUs is strongly influenced by (1) whether intensivists are providing patient

Study design

This study was part of a larger National Science Foundation–funded study of tele-ICU nurses (http://cqpi.engr.wisc.edu/vicu_home). We conducted semistructured interviews with tele-ICU managers, physicians, and nurses to obtain rich in-context qualitative data about the potential contributions of tele-ICU technology to patient outcomes. We did not collect quantitative data because they were not relevant for our research's objective. Qualitative research is appropriate when relatively little is

Results

A total of 61 tele-ICU staff (10 managers, 15 physicians, and 36 nurses) from 5 tele-ICUs participated in the study. A total of 722 pieces of data were coded into 28 nodes describing contributions of the tele-ICU to care processes and outcomes (Table 3, Table 4). Six hundred thirteen comments were assigned to 19 nodes of positive contributions (Table 3), and 109 comments were assigned to 9 nodes of negative contributions (Table 4). Seven themes emerged from our analysis. Below, we describe the

Conclusions

In this study, we were able to identify contributions that the tele-ICU provided to critical care processes and outcomes. The tele-ICU managers, physicians, and nurses whom we interviewed discussed more positive tele-ICU contributions than negative contributions. Below, we discuss 5 pertinent findings about the contributions of tele-ICU.

Acknowledgments

We thank all tele-ICU staff for taking the time to participate in the study; this research was not possible without them. We also want to thank Dr Kenneth Wood for his assistance with the study and Christine G. Holzmueller, BLA, for her assistance in editing the manuscript.

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    Institutions where work was performed: Five tele–intensive care units across the United States.

    ☆☆

    Financial support: This research study was partly funded by the National Science Foundation (OCI-0838513; principal investigator: Pascale Carayon, PhD).

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