Determinants of Intensive Care Unit Telemedicine Effectiveness: An Ethnographic Study.

Determinants of Intensive Care Unit Telemedicine Effectiveness: An Ethnographic Study.

Am J Respir Crit Care Med. 2018 Oct 23;:

Authors: Kahn JM, Rak KJ, Kuza CC, Ashcraft LE, Barnato AE, Fleck JC, Hershey TB, Hravnak M, Angus DC

Abstract
RATIONALE: Telemedicine is an increasingly common care delivery strategy in the intensive care unit (ICU). However, ICU telemedicine programs vary widely in their clinical effectiveness, with some studies showing a large mortality benefit and others showing no benefit or even harm.
OBJECTIVES: We sought to identify the organizational factors associated with ICU telemedicine effectiveness, as measured by improvements in risk-adjusted mortality after adoption.
METHODS: We performed a focused ethnographic evaluation of 10 ICU telemedicine programs using site visits, interviews, and focus groups in both facilities providing remote care and the target ICUs. Programs were selected based on their change in risk-adjusted mortality after adoption (decreased mortality, no change in mortality, and increased mortality). We used a constant comparative approach to guide data collection and analysis.
MEASUREMENTS AND MAIN RESULTS: We conducted 460 hours of direct observation, 222 interviews, and 18 focus groups across 6 telemedicine facilities and 10 target ICUs. Data analysis revealed three domains that influence ICU telemedicine effectiveness: leadership (i.e., the decisions related to the role of the telemedicine, conflict resolution, relationship building); perceived value (i.e., expectations of availability and impact, staff satisfaction, understanding of operations); and organizational characteristics (i.e., staffing models, allowed involvement of the telemedicine unit, new hire orientation). In the most effective telemedicine programs these factors led to services that are viewed as appropriate, integrated, responsive, and consistent.
CONCLUSIONS: The effectiveness of ICU telemedicine programs may be influenced by several potentially modifiable factors within the domains of leadership, perceived value, and organizational structure.

PMID: 30352168 [PubMed - as supplied by publisher]