TY - JOUR
T1 - Staff acceptance of tele-ICU coverage
T2 - A systematic review
AU - Young, Lance Brendan
AU - Chan, Paul S.
AU - Cram, Peter
N1 - Funding Information:
In a systematic review of staff acceptance of tele-ICU coverage, we found that this technology generally was viewed favorably by physicians and nurses across an array of settings. In particular, staff generally viewed tele-ICU coverage as improving ICU quality despite initial reservations regarding the implementation of these systems. Staff also expressed the strong belief that the benefit of tele-ICU coverage would be greater for ICUs with specific quality issues (eg, difficulty in obtaining staffing) that could be affected. Our review also revealed important limitations in the methodologic rigor of many studies, highlighting the need for better evaluation of this costly new technology. A number of our findings merit further discussion. First, it is important to address the quality and rigor of the available data. Although we identified 23 studies meeting our inclusion criteria, only seven were peer-reviewed studies that focused primarily on staff acceptance, 30,33,34,36,38,40,41 and validated survey instruments were used in only two studies. 34,41 This lack of rigorous data places hospital administrators and intensivists contemplating implementation of tele-ICU coverage in a difficult situation. Second, our results suggest that staff acceptance of tele-ICU coverage is generally high. Although staff members have appropriate concerns about the impact of this technology ahead of implementation, most studies suggest that those who have worked in an ICU with tele-monitoring view the technology favorably. Third, our review suggests that context matters. In other words, staff members seem to appreciate the fact that the benefit of tele-ICU coverage depends on the baseline performance of the ICU where coverage is initiated. In particular, ICUs with poorer baseline performance or more-significant challenges might benefit more, whereas ICUs with better baseline performance might benefit less. One could argue that this assumption is intuitive, but at the present time, it is actually quite uncertain which hospitals are choosing to implement tele-ICU coverage. Indeed, it is possible that ICUs with highly engaged intensivist leaders and high baseline quality may be the facilities choosing to purchase these systems. Fourth, our review highlights several specific strategies that might facilitate tele-ICU acceptance by staff. ICU clinicians should participate early in the design and implementation of the tele-ICU. 34 Physicians and hospital administrators should build support for tele-ICU coverage among the ICU staff prior to rollout. 22,34 Clinicians from the monitoring center should visit the bedside teams in order to build trust on both sides of the camera. 29,40 Audiovisual contact with the teleconsultant is better than audio contact alone. 22,28 Hiring monitoring center physicians and nurses skilled in interpersonal communication is important for reducing the threat perceived by bedside teams. 40 The findings allow us to speculate on additional ways to facilitate integration of the tele-ICU. Uncertain and conflicting treatment approaches undermine patient care, so hospital administrators must establish absolute agreement between the ICU staff and the monitoring center on best practices for operation. Procedures for physician-to-physician sign-out should be explicit so that ICU nurses know at all times the scope of the tele-ICU consultants' authority. Administrators should encourage nurses to identify conflicting treatment directives and provide clear instructions for resolving those conflicts for the best care of the patient. Administrators also could enhance acceptance and decrease suspicion by arranging periodic face-to-face meetings or site visits for bedside and consulting clinicians. Our review has several limitations. First, most of the included studies addressed staff acceptance only as a secondary consideration, so the level of detail reported often was deficient. Second, the heterogeneity of study designs and measures prevented us from conducting meta-analyses of the reported quantitative data. Nevertheless, the reporting of qualitative results was a strength of this review. Third, all but one study neglected to evaluate tele-ICU acceptance among administrators. This omission is important because administrators were typically the ones who determined whether tele-ICU coverage was purchased and implemented. Finally, acceptance by patients and families was not examined in the studies in this review and merits further investigation. In conclusion, we found that although tele-ICU coverage was initially viewed with trepidation, after implementation, staff viewed this technology as improving ICU functioning in a number of diverse ways. This study highlights the need for careful planning and staff involvement prior to implementation of what can be viewed as a threatening and disruptive technology. Author contributions: Dr Young had full access to the data and vouches for the integrity of the data analysis. Dr Young: contributed to the conduct of the literature search and the analysis and wrote the original draft of the manuscript. Dr Chan: contributed to the analysis and multiple revisions of the manuscript. Dr Cram: contributed independent evaluation of the studies, to the analysis, and to the revision of subsequent drafts of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST to following conflicts: Dr Cram has received grant funding from the Veterans Administration for the research presented in this article and has given talks on tele-ICU but has not received or ever received funding from any corporate entities or other entities with a financial stake in tele-ICU care. Drs Young and Chan report that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Role of sponsors: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The funding sources had no role in the analyses or drafting of this manuscript.
PY - 2011/2/1
Y1 - 2011/2/1
N2 - Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems(aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage(measured in 70% of studies), impact on patient care (measured in 96%), impact on staff(measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by >82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.
AB - Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems(aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage(measured in 70% of studies), impact on patient care (measured in 96%), impact on staff(measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by >82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.
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U2 - 10.1378/chest.10-1795
DO - 10.1378/chest.10-1795
M3 - Review article
C2 - 21051386
AN - SCOPUS:79551608198
SN - 0012-3692
VL - 139
SP - 279
EP - 288
JO - Chest
JF - Chest
IS - 2
ER -