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2015 HSR&D/QUERI National Conference Abstract

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3068 — Teamwork and ICU Telemedicine

Moeckli J, Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System; Goedken CC, Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System; Thomas JT, Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System; Cram P, University of Toronto; Reisinger HS, Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System;

Objectives:
Teamwork in intensive care units (ICUs) is shown to affect quality and safety of patient care. ICU team performance frameworks have been developed to characterize the relationship between teamwork and performance in support of developing team training and interventions in ICUs. However, current frameworks do not address the unique challenges to teamwork posed by ICU telemedicine, despite its growing presence. We use findings from an 18-month formative evaluation of a VHA ICU Telemedicine program to identify key differences in teamwork that may expand the applicability of team frameworks to virtual ICU teams.

Methods:
We conducted semi-structured interviews with 94 staff at 7 ICUs and the ICU Telemedicine support center, including administrators, physicians, nurses, respiratory therapists, and support center intensivists and nurses. Interviews were conducted between July 2011-May 2012, at 6-12 weeks and one year post-implementation. Transcribed interviews were analyzed for thematic content, and a matrix analysis was performed.

Results:
Although similarities were noted with co-located teamwork, four broad themes emerged that distinguished virtual team structure, behavior, and function: 1) Presence and Distance; 2) Technology; 3) New Role; and 4) Autonomy and Collaboration. Presence and Distance characterizes the limitations and benefits of being apart and outside of physical ICUs, including information needs and regulated access to patients and staff. Technology includes the interceding role of clinical and communication technologies in care and work practices, from technological failures to changes in technology use as relationships develop. New Role characterizes perceptions of this new type of care provider and practice. Autonomy and Collaboration addresses the tension expressed in adapting to a new paradigm of care.

Implications:
ICU telemedicine is a complex socio-technical system that complicates how teamwork is conceptualized. We identified four themes that could be used to refine teamwork constructs and their relationships to expand the applicability of frameworks for virtual ICU teams. Differences between team types also indicate the need for training, intervention, and evaluation techniques designed to address comprehensive teamwork performance in ICU telemedicine systems.

Impacts:
ICU team performance frameworks need to account for the impact of ICU telemedicine on teamwork to be comprehensive and useful in developing appropriate interventions and team training.