"Doc in a Box": Challenges of Integrating a Virtual Team into Patient Care in Intensive Care Units (ICUs)

Reisinger HS, Moeckli J, Cunningham CL, Cram PM. "Doc in a Box": Challenges of Integrating a Virtual Team into Patient Care in Intensive Care Units (ICUs). Poster session presented at: American Anthropological Association Annual Meeting; 2013 Nov 21; Chicago, IL.

Related HSR&D Project(s)

• IIR 09-336 – The Impact of Remote ICU Monitoring on Patient Outcomes and Processes of Care

Multidisciplinary, team-based care is essential in ICUs. For example, daily rounds in ICUs include intensivists (physicians who specialize in critical care), medical trainees, and nurses, as well as respiratory therapists, pharmacists, dieticians, and social workers. These daily rounds allow healthcare teams to communicate with each other to insure a common understanding of the care plan for each critically-ill patient. A growing trend in ICU care is the inclusion of a Tele-ICU, or virtual team of critical care nurses and intensivists. This trend has increased due to research supporting the benefits of 24/7 intesivist coverage of ICUs and the shortage of clinicians trained in critical care. Tele-ICUs include critical care nurses and intensivists monitoring and consulting with bedside ICUs with the assistance of audio/video linkage, electronic medical records, and real-time access to vitals. Our research team has conducted fieldwork with a Tele-ICU in the Veterans Healthcare Administration. The Tele-ICU support center connects with 9 ICUs in 6 states in the Upper Midwest and West. We conducted site visits, including observations and interviews, with the Tele-ICU support center and 5 of the 9 bedside ICUs. We also conducted telephone interviews with key stakeholders at 2 additional ICUs. One of the major themes emerging from the research was the challenge of incorporating virtual ICUs teams into the established ICU teams at the bedside. This paper explores the variation in how the bedside ICUs integrated the Tele-ICU into a new "hybrid team" of virtual and bedside members-or resisted the inclusion of virtual members.