Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits

Goedken, Cassie Cunningham; Moeckli, Jane; Cram, Peter; Reisinger, Heather Schacht

doi:10.1016/j.iccn.2016.10.001

Cited by 22 publications

(15 citation statements)

References 20 publications

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“…The most disruptive implementation of ICT in intensive care medicine in the recent past has been the introduction of tele-ICUs, which has been accompanied by several staff acceptance studies [21,52,53]. With the implementation of tele-ICU technology in existing ICUs, ICU staff are not only confronted with novel ICTs, but also with changes in clinical processes, such as teamwork, communication, and staff structure.…”

Section: Discussionmentioning

confidence: 99%

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Poncette¹,

Spies²,

Mosch³

et al. 2019

JMIR Med Inform

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BackgroundIn the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s.ObjectiveThe aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring.MethodsThis prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach.ResultsEvaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies.ConclusionsThis qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite.Trial RegistrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk)

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Section: Discussionmentioning

confidence: 99%

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Poncette¹,

Spies²,

Mosch³

et al. 2019

JMIR Med Inform

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“…Evidently, if tele-ICU nurses can facilitate communication with the ICUs, this strategy can help in reducing or mitigating problems with the relationship with the ICUs 8,35 . If the ICU staff realizes that the tele-ICU is there to help and assist them, instead of being “Big Brother” and controlling what they do, that may improve the relationship 7 .…”

Section: Discussionmentioning

confidence: 99%

“…However, within healthcare organizations that have several hospitals and ICUs, processes and technolgy can be standardized with often very positive outcomes 36 . And tele-ICU implementation itself often has some standardization of care as a result 35 .…”

Section: Figurementioning

confidence: 99%

Work System Barriers and Strategies Reported by Tele-Intensive Care Unit Nurses

Hoonakker

Carayon

2018

Critical Care Nursing Clinics of North America

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Tele-intensive care units (ICUs) are an innovation to handle issues such as personnel shortage and improving care. In tele-ICUs, clinical teams monitor ICU patients remotely and support clinicians in multiple ICUs. The tele-ICU and ICU clinicians function as virtual teams. Little is known how these teams function and what challenges they encounter. We examined the challenges from the perspective of nurses in a tele-ICU. We used a case study design and conducted interviews with 10 tele-ICU nurses. The nurses encounter challenges in interacting with the multiple ICUs that they monitor remotely and have developed strategies to cope with these challenges.

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“…A consultation is initiated by staff pressing a button that alerts the TNOC, where separate monitors display to the physicians and nurses bedside video of the patient, the EHR, ICU clinical information system electronic flowsheets, and bedside physiological monitors, along with teleconferencing capability. Research has shown that access to tele-ICU programs reduces the number of transfers to tertiary hospitals (Goedken, Moeckli, Cram, & Reisinger, 2017).…”

Section: Exemplarsmentioning

confidence: 99%

Big Data in the Veterans Health Administration: A Nursing Informatics Perspective

Phillips

Davis

et al. 2021

J of Nursing Scholarship

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Purpose This article reviews the missions of the U.S. Department of Veterans Affairs (VA) and the evolution of its electronic health record (EHR), the Veterans Health Information Systems and Technology Architecture (VistA). This system, along with its clinical graphical user interface the Computerized Patient Record System, form a key link in VA health care. A Veteran who receives healthcare through the VA can have their EHR accessed by clinicians at any VA healthcare facility across the United States and its territories. Data aggregated daily at a corporate data warehouse supports VA quality improvement and research. Organizing Construct Serving over 9 million Veterans, the VA is one of the largest integrated healthcare systems in the United States. It has been a leader in the development and use of healthcare informatics, EHR, and big data analytics for over 30 years. Nurses engaged in major roles in the evolution of these developments. Conclusions With over 500 nurses as members, the Office of Nursing Informatics’ Field Alliance demonstrates the VA’s continuing commitment to fostering nursing informatics. The commitment includes investment by the VA to develop nursing informaticists from among its own staff. Clinical Relevance Exemplars of the impact of nursing informatics are shared. Future directions include an EHR that begins during military service and follows the Veteran into VA health care.

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Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits

Cited by 22 publications

References 20 publications

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study

Work System Barriers and Strategies Reported by Tele-Intensive Care Unit Nurses

Big Data in the Veterans Health Administration: A Nursing Informatics Perspective

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