Making the Move: From Bedside to Camera-Side

Abstract

The tele–intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity for career and knowledge expansion while reducing some of the physical and emotional risks encountered at the bedside. The role of the tele-ICU is still evolving but focuses on 4 areas of responsibility: performing virtual rounds, managing patient alerts, providing ICU support, and coaching or providing teaching moments. The transition from the bedside into the tele-ICU role can be complex as tele-ICU nurses encounter ICU acceptance barriers and a lack of or a change in professional identity. A formal orientation program focused on competency is necessary for the successful transition from bedside nurse to tele-ICU nurse.

Partnership for a Healthy Work Environment

“…15,16,25 The ICU staff appear less hesitant to respond in a negative manner to a disembodied voice in the room without a facial connection (1-way video), which may further reduce the collegiality of the relationship and potentially put patient safety at risk. The same hesitancy experienced by a bedside nurse, when a change in a patient's status necessitates contacting a physician with a history of being unpleasant, is experienced by the tele-ICU nurse when repeatedly spurned by the bedside team.…”

“…Twoway audio and video capabilities allow bidirectional communication with in-room staff, physicians, or the patient and family. 7,8,15,16 The typical tele-ICU nurse monitors care to 30 to 40 ICU patients, and depending on the program design, a tele-ICU physician may care for 100 to 250 patients. The tele-ICU does not replace bedside resources; instead, it encircles the ICU with constant supportive and adjunctive care.…”

“…8,[13][14][15][16] The HWE initiative can be a very effective platform for constructing the ICU/tele-ICU partnership. Both the tele-ICU and the ICU may be on parallel journeys toward establishing an HWE in an effort to improve care.…”

Technology in Health Care

“…Tele-ICUs provide critical care to remote hospitals that typically are not able to provide this service. 164,165,[167][168][169] Nurses who practice in a Tele-ICU setting must practice according to the standards of nursing care as set forth by the American Nurses Association, the American Academy of Ambulatory Care Nursing, and their state licensing board. Tele-ICU staff are capable of communicating directly to the nurses at the remote hospital location.…”

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine

“…11,12 Physicians trained as intensivists who provide care via tele-ICU have been able to help fill this gap in order to deliver more effective healthcare. 13 It has been suggested that tele-ICU implementation and utilization have the potential to be as effective as having dedicated intensivists in the ICU 24 h/day, relieving taxed staff, and providing quality care to the ever-increasing ICU patient population. 10 The purpose of this study was to determine the potential impact and direction of the implementation of the tele-ICU in hospitals to assess current benefits and barriers of adoption of this technology.…”