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Telemedicine Survey Shows Strong Support From ICU Nurses

A majority of tele-ICU nurses say the remote care concept is valuable to them and their patients, while some of the biggest barriers are focused on attitudes.

- A survey of some 1,200 nurses around the country who work in tele-ICU or eICU environments finds strong support for the remote clinical care platform.

Connie Barden

The largest barrier to tele-ICU expansion? Negative attitudes within healthcare.

According to the survey, conducted by the Chicago-based Rush University Medical Center’s Center for Clinical Research and published in this month’s American Journal of Critical Care, more than 60 percent of the nurses surveyed agree that tele-ICUs improve collaboration, job performance and communication and enables them to accomplish tasks more quickly.

“(It’s) one of the most unique fields that I have worked so far, (with) a vast potential in terms of reaching out and enhancing patient safety and care,” one respondent said.

The survey identified roughly 45 tele-ICUs in the country, able to monitor more than 6,000 patients in 200+ hospitals, or roughly 12 percent of the nation’s ICU patients. The tele-ICUs are staffed by 800 to 1,000 nurses, connecting with another 16,000 staff nurses alongside the patients.

Of the barriers cited, it’s interesting to note that 45 percent of those surveyed listed attitudes of ICU staff members as the strongest deterrent to tele-ICUs, and more than 40 percent said tele-ICUs were “perceived as interference.” Roughly 23 percent of those surveyed also listed attitudes of tele-ICU staff and “collegial respect” as barriers. In other words, perceptions and opinions are apparently as powerful as clinical or financial issues in the development of telemedicine.

Connie Barden, RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses (AACN), which funded the project, said the survey’s results point to the need for more education on collaborative care.

“This is a new way for teams to relate to one another,” she said, “and assuring skilled communication and true collaboration are in place will go a long way in ensuring success.”

Other barriers cited were technical problems and audio issues, which each garnered more than 40 percent; interruption of care, which polled at about 30 percent; and video issues, which came in at about 25 percent.

Officials said the survey’s results will help develop a game plan for more tele-ICUs and the nurses to properly staff them.

“Tele-ICUs improve patient care by providing an enhanced monitoring capability to detect potential patient compromise earlier,” Ruth Kleinpell, RN, PhD, APRN-BC, CCRN, the Center for Clinical Research’s director and the study’s lead author, said.  They also “help promote collaborative care by using telehealth nursing and physician staff and on-site clinical staff to collectively manage patient care issues, as well as to enhance communications with patients and family members.”

“In rural areas, it is possible for tele-ICUs and other forms of telehealth to help fill the void if an area lacks a specialist,” Barden added. “To have a specialist offer a remote consult means getting the right care to the patient in a timely manner. Besides being a financially efficient way of delivering care, it may also help to keep the patient in their local area rather than needing transfer for care hundreds of miles away. So, it can save money and keep the patient with their family.”

The survey also pointed out that the tele-ICU nurse’s job is challenging – it requires “a mix of common and unique skills” and “tremendous interpersonal relationships (and) and effective communication with a variety of disciplines,” respondents noted.

Barden said that information will help the AACN in maintaining its Tele-ICU Nursing Practice Guidelines and the CCRN-E certification designed specifically for tele-ICU nurses.

“The information from the study helps to inform us about skills, knowledge and competencies needed by tele-ICU nurses. How these competencies evolve over time will be worth future study,” she said. “This important certification validates that tele-ICU nurses possess the same critical care knowledge and skills as their colleagues at the bedside.”

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