| Description |
Current intensive care unit trends show an increase in the number and severity of patients. Consequently, the need for providers specializing in critical care medicine is also increasing. Medical management by an intensivist has been shown to improve ICU patient outcomes, yet there are not enough intensivists to meet the population's demand. Many providers that have training in other areas, not critical care, are providing care to these patients, especially in smaller or rural hospitals. In order to ensure best outcomes for all patients, telemedicine in critical care has been implemented in the United States to provide support to these providers. Initial adoption of this technology was rapid. However in recent years, its use has slowed tremendously. This project aimed to discover and address factors that affect provider acceptance of telecritical care (TCC), thereby contributing to the knowledge of successful telemedicine implementation strategies. The purpose of this project were to identify components and outcomes of current ICU teleservices in the United States, examine provider acceptance and satisfaction of a TCC program, make recommendations based on analysis and disseminate study findings to a wider audience. TCC has been shown to improve access to care and clinical experts, increase patient and family satisfaction and potentially conserve resources. However, the success of these outcomes is correlated with the level of tele-ICU acceptance. Provider acceptance, support and input, along with successful program implementation is crucial when adopting new technology. While there is evidence documenting potential barriers to adoption, more research is needed to identify how telecritical care might adapt to better fit provider and patient needs. To implement the objectives of this project, a literature review was performed to identify current trends of use and appropriate outcomes for the project. Providers at four hospitals using TCC consultation services were interviewed using an interview guide. Their responses were recorded and a team of experts was assembled to assist in simple descriptive analysis. Common themes were identified and data was categorized with the frequency of statements. The results from this analysis and literature review were synthesized into a report of recommendations for managing barriers and promoting facilitators to TCC services. This report was presented and submitted to the teleservices department. These objectives were evaluated through the approval of the project chair and content experts, the completion of the data analysis, the creation of a written report of recommendations and by the presentation of findings to the teleservices department. Analysis of interviews revealed mixed provider feelings about the transition to TCC. Six of eight providers found the service helpful and appreciated having an "extra set of eyes" on patients with confirmation of their treatment plans. Other facilitators included the promptness of TCC consultation, detailed notes and recommendations, and assistance with transfers to higher levels of care. Barriers to the service centralized around the lack of clarity of provider roles, conflicting orders, and unnecessary or disruptive calls. Overall, most providers saw improvements in patient care and appreciated having back up for unfamiliar interventions. Telemedicine in critical care will likely continue to evolve and be implemented throughout the nation. If further acceptance research is not conducted, the potential barriers may be too overwhelming for widespread adoption of a very useful tool in patient care. This project has contributed to the current knowledge of provider acceptance at this healthcare system and will provide a foundational analysis for continued program modification and evaluation. |
