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Staff Acceptance of Tele-ICU Monitoring
Moeckli J, Cram PM, Cunningham CL, Reisinger HS. Staff Acceptance of Tele-ICU Monitoring. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 19; National Harbor, MD.
Tele-ICU monitoring allows off-site critical care staff to provide advice to bedside patient care teams. Available data suggest Tele-ICUs may improve patient outcomes, but acceptance by bedside staff is uncertain. We used qualitative methods to evaluate VISN 23 staff perceptions of the Tele-ICU before and after system implementation.
We conducted group and individual interviews and performed daytime and nighttime observations at the Tele-ICU monitoring center and four of eight ICUs implementing the Tele-ICU system. Pre- and post-implementation interviews were conducted with monitoring center physicians (n = 2) and nurses (n = 7); ICU physicians (n = 5) and nurses (n = 43); and respiratory therapists (n = 8). Interviews were conducted between July-September 2011, between 1-3 weeks pre- and 6-12 weeks post-activation of the Tele-ICU system. Interviews addressed: 1) anticipated and actual use; 2) perceived effectiveness; and 3) facilitators and barriers to implementation. Transcribed interviews and field notes were content analyzed, and a matrix analysis was performed.
Before activation, academic-affiliated ICU staff expressed more ambivalence about potential benefits of the Tele-ICU, whereas participants in rural ICUs were more accepting. After activation, perceptions about Tele-ICU effectiveness became more defined and varied based on: 1) realization (or not) of expected benefits; 2) discovery of unanticipated benefits; 3) first encounters with the monitoring center; and 4) perceived need for additional resources. Framing the Tele-ICU as increasing patient safety, as additional support for bedside nurses (e.g., charting), and as a medical resident teaching tool appear to increase support for the system. Barriers to implementation related to discomfort with being monitored, and confusion about how the Tele-ICU worked and how it was expected to improve bedside care.
Tele-ICUs are complex socio-technical systems. Education about the Tele-ICU system, positive first encounters with the monitoring center, and access to intensivists as a teaching resource appeared to be associated with greater staff acceptance. Poor communication before and after implementation and uncertainty about the need for additional monitoring and consultation were frequently associated with unfavorable views of the system.
Time and resources for staff training, developing rapport, and establishing clear expectations for Tele-ICU interventions are necessary to maximize acceptance of this complex new technology.