Participants also cited several barriers: audio and video technical problems, interrupting care, perceptions that telemedicine is an interference, and attitudes of ICU staff.

“One of the limitations of the use of tele-ICUs is the associated costs of implementing the systems,” she said. “Several studies have demonstrated a cost savings downstream by reducing adverse events and shortening length of stay, but other studies have demonstrated mixed results.”

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In phase 2 of the study, 60 respondents developed a ranked list of 15 priority areas of care for tele-ICU nursing. The most important ranked abilities overall were critical thinking skills, having ICU experience, skillful communication, mutual respect for bedside and tele-ICU colleagues, and emergency patient care management.

According to the study, the United States has approximately 45 tele-ICUs that reach more than 200 hospitals and has monitoring capability for more than 6000 beds — or 12% of ICU patients in the United States. The researchers estimate that 800 to 1000 nurses currently practice in tele-ICUs and more than 16 000 bedside nurses interface with these units.

The American Association of Critical-Care Nurses (AACN) funded the study with an Impact Research Grant.

“There has been limited research related to many aspects of using tele-ICUs,” Dr Kleinpell said. “Additional research is needed related to ways to develop and enhance critical thinking skills and skillful communication with use of telehealth, best staffing models for tele-ICU care, opportunities for new models of care to develop in using telehealth, cost effectiveness of tele-ICUs, outcomes related to tele-ICU’s and as highlighted in the study, telehealth nursing competencies.”


Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJZ. Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units. Am J Crit Care. 2016; doi:10.4037/ajcc2016808.