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.”
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.”