3014 — The ICU Telemedicine Black Box: Qualitative Analysis of Telemedicine Utilization in VA Intensive Care Units

Thomas JT, CADRE; Moeckli J, CADRE; Goedken CC, CADRE; Bunch J, CADRE; Cram P, University Health Network, University of Toronto; Reisinger HS, CADRE;

Objectives:
Studies of intensive care unit (ICU) telemedicine programs have shown mixed results in lowing mortality and reducing length of stay among other patient outcomes. Few studies, however, have analyzed how ICU staff use ICU telemedicine on a day-to-day basis or have examined utilization from a bedside ICU staff perspective. The objective of this study is to characterize utilization patterns of an ICU telemedicine program from the perspective of bedside ICU staff across seven ICUs in the Veterans Health Administration (VHA).

Methods:
Semi-structured interviews were conducted with 116 nurses, physicians, and respiratory therapists at seven ICUs in the VHA approximately 8 weeks and one year after implementation of an ICU telemedicine program. Thematic content analysis was then undertaken to characterize bedside perspectives of ICU telemedicine utilization.

Results:
ICU telemedicine utilization varies widely as described by bedside ICU nurses and physicians. We identified three thematic categories associated with ICU telemedicine utilization: 1) General ICU Patient Care, 2) ICU Clinical Decision Making, and 3) Urgent ICU Patient Care. General ICU Patient Care was characterized by requests for documentation, observation, rounding with bedside staff, and technical support. Clinical Decision Making included discussions of clinical practice and standardization of care/best practices, as well as direct requests for clinical assistance such as new orders, ventilator consultation, and review of lab results. Urgent ICU Patient Care included code situations and alerting ICU staff to patient physiological deterioration. Nursing staff provided examples from all three categories, while physicians described ICU telemedicine utilization only for clinical decision making and in urgent situations.

Implications:
ICU telemedicine utilization ranges from general patient care to assistance with urgent situations. Variation in utilization patterns may impact the measured effectiveness of ICU telemedicine programs and lead to the mixed results of quantitative studies.

Impacts:
An agreed upon typology for documenting ICU telemedicine utilization is needed in order to better measure its effectiveness on patient outcomes.