Telemedicine is changing the way patient care is provided in a growing number of intensive care units (ICUs) across the country, and tele-ICU nurses – who see its impact firsthand – say it provides an opportunity to improve care, according to results of a national survey published in the American Journal of Critical Care (AJCC).
The article, “Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units,” reports the results of a two-phase study to assess nurses’ perceptions of ICU telemedicine and identify priority areas for tele-ICU nursing.
According to the study, the United States has approximately 45 tele-ICUs with monitoring capacity for more than 6,000 patients at over 200 hospitals, impacting care for an estimated 12 percent of ICU patients in the country. Between 800 and 1,000 nurses currently practice in tele-ICUs, interfacing from remote monitoring sites with another 16,000 staff nurses who are at the bedside.
Lead author Ruth Kleinpell, RN, PhD, APRN-BC, CCRN, is director of the Center for Clinical Research at Rush University Medical Center, Chicago, and a professor at Rush University College of Nursing.
“The majority of participants thought that tele-ICUs enhanced patient care, improved productivity and collaboration and made their job easier,” Kleinpell said. “This growing subspecialty of critical care nursing has tremendous potential to affect patients, patients’ families and the entire healthcare team.”
The national benchmarking survey of tele-ICU nurses identified barriers and benefits to telemedicine with respect to nursing care. The study also assessed priority areas of care for tele-ICU nurses to form the foundation for developing competencies for tele-ICU nursing.
A total of 1,213 nurses responded to the initial online survey, three-quarters of whom were hospital-based bedside nurses who interface with a tele-ICU. Another 13 percent were nurses who work in a remote tele-ICU location, and approximately 10 percent were nurses who work in both capacities.
More than 75 percent of participants agreed or strongly agreed that tele-ICU systems offer nurses an opportunity to improve patient care and that tele-ICU is useful in their job.
A majority also agreed that tele-ICUs improve collaboration, job performance and communication, as well as being useful in nursing assessments and allowing bedside nurses more time for patient care.
Specific benefits to using tele-ICU systems include:
- Monitor trends in vital signs
- Detect unstable physiological status
- Provide medical management
- Enhance patient safety
- Detect arrhythmias
- Prevent self-extubation
- Prevent falls
Participants also identified barriers related to tele-ICUs, including technical problems (audio and video), interrupting care, perceptions of telemedicine as an interference and attitudes of ICU staff.
During the second part of the study, 60 respondents developed a ranked list of 15 priority areas of care for tele-ICU nursing. Critical thinking skills, ICU experience, skillful communication, mutual respect and emergency patient care management were ranked as the most important abilities overall.
The American Association of Critical-Care Nurses (AACN) funded the project team’s study with an Impact Research Grant, which supports clinical inquiry that drives change in high acuity and critical care nursing practice.
The findings can be used to further inform the development of competencies for tele-ICU nursing as recommended in “AACN’s Tele-ICU Nursing Practice Guidelines.”