Making the move: from bedside to camera-side

Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review

In the context of the COVID-19 pandemic, many healthcare and social services professionals have had to provide services through virtual care. In the workplace, such professionals often need to be sufficiently resourced to collaborate and address collaborative care barriers in telehealth. We performed a scoping review to identify the competencies required to support interprofessional collaboration among clinicians in telehealth. We followed Arksey and O'Malley's and the Joanna Briggs Institute's methodological guidelines, including quantitative and qualitative peer-reviewed articles published between 2010 and 2021. We expanded our data sources by searching for any organization or experts in the field via Google. The analysis of the resulting thirty-one studies and sixteen documents highlighted that health and social services professionals are generally unaware of the competencies they need to develop or maintain interprofessional collaboration in telehealth. In an era of digital innovations, we believe this gap may jeopardize the quality of the services offered to patients and needs to be addressed. Of the six competency domains in the National Interprofessional Competency Framework, it was observed that interprofessional conflict resolution was the competency that emerged least as an essential competency to be developed, while interprofessional communication and patient/client/family/community-centered care were identified as the two most reported essential competencies.

A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia

BACKGROUND

Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site.

METHODS

This retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation.

RESULTS

1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%.

CONCLUSION

vCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care.

2019 John M. Eisenberg Patient Safety and Quality Awards: A Model Cell for Transformational Redesign of Sepsis Identification and Treatment: Aligning Digital Tools with Innovative Workflows

BACKGROUND

Readmission after hospitalization, increased morbidity, and high levels of mortality are not uncommon in patients diagnosed with sepsis. Sepsis bundles designed to mitigate the deleterious effects have been recommended for nearly a decade. Despite this, mortality remains high, sepsis bundle requirements controversial, and bundle compliance low.

METHODS

A health system implemented a multidisciplinary project to decrease the mortality rate of sepsis. A Model Cell mental model was adopted. Data on mortality and compliance were gathered from four acute care hospitals in the system and analyzed. The observed mortality data were compared to predictive data based on comparable acute care facilities.

RESULTS

Regression analysis showed significant increases in bundle compliance rates at each site (p < 0.05), reflecting the continuous use of the methods described above. Mortality systemwide decreased significantly in response to increased bundle compliance (r = 0.80, r² = 0.64, p < 0.001), with compliance alone accounting for nearly two thirds of the variance in the linear model. The observed results revealed a median mortality rate of 5.7% (95% confidence interval [CI] = 5.1%-7.3%, n = 23), 1.9 percentage points lower than predicted when compared to similar institutions. When using only the final 12 months of the project, the median mortality drops further to 5.3% (95% CI = 3.9%-5.6%, n = 12), 2.5 percentage points less than predicted.

CONCLUSION

The Model Cell intervention was successful in increasing bundle compliance, which then decreased mortality. This model can be enhanced as technology improves and is well positioned for artificial intelligence to help drive further success.

Evolution of the Intensive Care Unit Telemedicine Value Proposition

Advances in clinical information sciences, telecommunication technologies, electronic health records, early warning systems, automated acuity assessment, and clinician communication support systems have allowed current-generation intensive care (ICU) telemedicine systems to address the inefficiencies of the failed advice-upon-request ICU telemedicine model. Value is related to the ability of health care systems to leverage ICU telemedicine resources to provide care. Local financial benefits of ICU telemedicine program implementation depend on changing behavior to better focus on activities that reduce the duration of critical illness and length of stay.

Telemedicine Intensive Care Unit Nursing Interventions to Prevent Failure to Rescue

BACKGROUND

Although telemedicine intensive care unit (tele-ICU) nurses are integral to the tele-ICU model of care, few studies have explored the influence of tele-ICU nursing interventions on preventing failure to rescue in critically ill patients.

OBJECTIVE

To determine how tele-ICU nurses characterize their interventions to prevent failure to rescue.

METHODS

This qualitative interpretive study recruited a purposive sample from 11 tele-ICU centers across the United States for structured open-ended interviews. An inductive and deductive approach suitable for health services qualitative research was adapted to further explain and extend a relevant conceptual framework for tele-ICU nursing practice.

RESULTS

Of 33 nurses practicing in tele-ICUs who responded to a recruitment email, 19 participated in this study. Findings included 4 major interrelated themes: (1) fundamental attributes of the tele-ICU nurse, (2) proactive clinical practice, (3) effective collaborative relationships, and (4) strategic use of advanced technology.

CONCLUSION

A conceptual framework extending the American Association of Critical-Care Nurses model of success for tele-ICU nursing practice is proposed to prevent failure to rescue. Tele-ICU nurses use systems thinking and integration of complex factors in their practice to prevent failure to rescue. Tele-ICU nurses' perception of their role in preventing failure to rescue and emotional intelligence competence are key to building and maintaining effective relationships with the ICU. Tele-ICU nurses' intentional use of advanced technology, rather than the technology itself, supports and enhances proactive tele-ICU practice to prevent failure to rescue.

A Mixed Methods Study of Tele-ICU Nursing Interventions to Prevent Failure to Rescue of Patients in Critical Care

Background: Failure to rescue (FTR) is a benchmark of quality care. Limited evidence exists examining the influence of telemedicine intensive care units (tele-ICU) nursing interventions in preventing FTR. The purpose of this study was to characterize tele-ICU nursing interventions and to determine which combination of documented tele-ICU nursing interventions (DTNI) best predicts prevention of FTR in ICU patients with hospital-acquired conditions (HACs). Materials and Methods: We used convergent parallel mixed methods design to conduct qualitative interviews with a purposive sample of tele-ICU nurses (n = 19) from 11 US tele-ICU centers. Quantitative data, including demographics, DTNIs, severity of illness scores, and video assessment times from January 2016 to December 2016 were retrieved for ICU patients discharged from a multihospital health system with a tele-ICU center (n = 861). Findings from both qualitative and quantitative analyses were merged, compared, and contrasted. Results: FTR patients had higher severity of illness, longer video assessment by tele-ICU nurses, and were more likely to have DTNIs related to hemodynamic instability. Four themes emerged from qualitative analysis: fundamental tele-ICU nurse attributes, proactive clinical practice, effective collaborative relationships, and strategic use of advanced technology. Mixed methods analysis revealed convergence between DTNIs and tele-ICU nurses' characterizations of their practice. Conclusions: Tele-ICU nurses' characterizations of their practice closely align with DTNIs. Tele-ICU nursing practice to prevent FTR involves systems thinking and integration of many complex factors. Tele-ICU nurses can reduce the odds of FTR with focus on support and clinical coordination interventions that avoid hemodynamic instability in ICU patients with a diagnosed HAC.

A Systematic Review of Nurses' Perspectives Toward the Telemedicine Intensive Care Unit: A Basis for Supporting Its Future Implementation in China?

Aim: The purpose of this systematic review is to critique and summarize existing research on intensive care unit (ICU) nurses' perspectives toward the telemedicine intensive care unit (Tele-ICU). The intention of this study is to explore the evidence base to support the potential future implementation of Tele-ICU program in China. Methods: We searched for published articles pertaining to Tele-ICU system with a centralized monitoring model between January 2000 and July 2017 using Cochrane Library, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, British Education Index, MEDLINE, MLA International Bibliography, and Web of Science. Studies were coded by methodology, participants, and findings. The textual narrative synthesis method was applied to synthesize the outcomes. Results: Findings were categorized as follows: perceptions of the Tele-ICU (including the role of Tele-ICU, benefits for nurses, patients, and management); attitudes of Tele-ICU (usefulness and challenges of Tele-ICU); level of satisfaction; factors affecting acceptance of Tele-ICU. Discussion: This review has synthesized significant factors influencing optimal usage of Tele-ICU from nurses' perspectives. Also, it might make a better case for findings to support Tele-ICU future implementation into Chinese tertiary hospitals.

Access to Continuing Education for Critical Care Nurses in Rural or Remote Settings

Caring for the critically ill does not occur solely in large medical centers or urban areas. Nurses practicing in rural or remote settings practice as nurse generalists, caring for a wide range of patients, including those needing critical care. As a nurse generalist, the need for a wide variety of skill sets challenges nurses in rural areas to maintain current practice through continuing education across many content areas. They also may not come in contact with critically ill patients or emergent situations as often as their urban counterparts, which can make remaining comfortable with more advanced skills difficult. Because nurses working in rural or remote areas may care for critically ill patients less often, the need to remain vigilant in pursuit of continuing education is increased; however, access to continuing education can be problematic because of geographic isolation, difficulty getting time off from work, limited financial resources, and perceived lack of applicable topics. With advances in technology, critical care nurses working in rural areas have more options for continuing education, which is crucial for maintaining a skilled nursing workforce in rural health care facilities. This article addresses challenges critical care nurses working in remote or rural areas face in pursuing continuing education and provides information about available educational opportunities.

Expanding technology in the ICU: the case for the utilization of telemedicine

INTRODUCTION

Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care.

MATERIALS AND METHODS

The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003-2013) in the English language. In total, 55 references were used for this research exploration inquiry.

RESULTS

Tele-ICU was found to be an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. Several case studies supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. Furthermore, it was noted that, although the initial costs for tele-ICU startup were significant, as much as $100,000 per bed, the benefits of the utilization of this technology can offset those costs by reducing costs by 24% via decreased length of stay for patients.

CONCLUSIONS

The findings of this study have suggested that the implementation of tele-ICU may have been more beneficial than costly, and it may have provided healthcare organizations the opportunity to increase quality of care and decrease mortality, while it might have decreased costs of delivering ICU services in both rural and urban areas.

Measuring tele-ICU impact: does it optimize quality outcomes for the critically ill patient?

AIMS

To determine the relationship between tele-ICU (intensive care unit) implementations and improvement in quality measures and patient outcomes.

BACKGROUND

Tele-ICUs were designed to leverage scarce critical-care experts and promised to improve patient quality.

EVALUATION

Abstracts and peer-reviewed articles were reviewed to identify the associations between tele-ICU programmes and clinical outcomes, cost savings, and customer satisfaction.

KEY ISSUES

Few peer-reviewed studies are available and many variables in each study limit the ability to associate study conclusions to the overall tele-ICU programme. Further research is required to explore the impact of the tele-ICU on patient/family satisfaction. Research findings are highly dependent upon the level of ICU acceptance.

CONCLUSIONS

The tele-ICU, in collaboration with the ICU team, can be a valuable tool for the enhancement of quality goals although the ability to demonstrate cost savings is extremely complex. Studies clearly indicate that tele-ICU nursing vigilance can enhance patient safety by preventing potential patient harm.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers and leaders play a vital part in optimizing the quality role of the tele-ICU through supportive modelling and the maximization of ICU integration.

Telemedicine in the intensive care unit

It is estimated if each hospital implemented intensivist physician staffing, approximately 55,000 lives and $4.3 billion dollars could be saved in the United States. However, there is a limited supply of new critical care specialists as teaching hospitals have decreased the size of critical care programs for financial reasons. Tele-ICU can be used to provide coverage in facilities that cannot support a full-time specialist in critical care medicine and as an adjunct to facilities without 24-hour intensivist coverage. This article discusses the benefits and challenges of tele-ICU and its implications for nursing practice.