Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units

Ruth Kleinpell, RN, PhD, APRN-BC, CCRN; Connie Barden, RN, MSN, CCRN-E, CCNS; Teresa Rincon, RN, BSN, CCRN-E; Mary McCarthy, RN, BSN; Rebecca J. Zapatochny Rufo, RN, DNSc, CCRN


Am J Crit Care. 2016;25(1):E14-E20. 

In This Article


The target of 350 participants for phase 1 of this study was greatly exceeded, with 1213 participants. This level of participation indicates that many nurses have an interest in examining how tele-ICU is affecting nursing practice. The finding that 921 of the respondents (76%) in phase 1 worked solely in the ICU setting is an important consideration in interpreting our results. For example, although barriers related to perceptions of interference and to interruptions in care were identified, the majority of participants thought that tele-ICU enhanced patient care, improved productivity and collaboration, and made their job easier.

Respondents in phase 1 reported that communication (60.4%) and collaboration (65.9%) were improved with tele-ICU, and skilled communication and mutual respect ranked high in both phases of the study (first and second in phase 1 and third and fourth in phase 2). Yet attitudes of ICU staff members were identified as a top barrier to using tele-ICU (45%), and attitudes of tele-ICU staff were also identified as a barrier (23.4%). This finding indicates a continued focus on understanding and implementing the principles of a healthy work environment at individual, institutional, and organizational levels. Further examination of the barriers identified in this study is needed to enhance knowledge related not only to tele-ICU nursing practice but also to general nursing attitudes and behaviors that may have adverse effects on the care of critically ill patients and the patients' families.

Other important areas of interest identified in this study are related to tele-ICU assistance with patient monitoring and safety and to critical thinking and advanced critical care nursing knowledge and experience. Knowledge translation, a process used to close the gap between creation of knowledge and use of that knowledge through synthesis, dissemination, and diffusion methods, has been advocated as a useful strategy for improving evidence-based practice in critical care.[14,15] A recently published multicenter study[2] indicated improved adherence to best-practice protocols and better mortality and length of stay in 56 ICUs in 15 states across the United States after implementation of tele-ICU services. Our results indicate that important priority areas for tele-ICU nursing practice involve both critical thinking and expertise and knowledge in critical care. Optimal leveraging of this experienced critical care workforce could be used to enhance implementation of best practices and optimization of outcomes of critically ill patients.

Our results add to the literature on tele-ICU nursing, which to date has included single-center observations and interviews of nurses who likened the nursing work to an air traffic control room[16] and an assessment of perceptions of tele-ICU among nurses in 3 ICUs in 2 settings that indicated general support of tele-ICU and concerns about privacy issues.[5]

Our results help address the lack of knowledge on the impact of tele-ICUs on ICU nursing care. Our identification of priority areas of tele-ICU nursing provides needed data for the development of competencies and optimization recommended in The AACN Tele-ICU Nursing Practice Guidelines.[7] In addition, the new knowledge can be used to identify areas for developing a research agenda for tele-ICU nursing care. Variations in the practice of ICU tele-medicine are well known, including tele-ICU staffing patterns, qualifications of providers, ICU staffing models, leadership and governance, and adherence to best practices.[3] Additional research is needed to further delineate issues related to tele-ICU that specifically affect nursing practice.

A recent systematic review[17] indicated that the cost of tele-ICU implementation is substantial and that the impact of these programs on hospital costs or profits is unclear. No information on costs related to tele-ICU nursing care or on alternative nurse staffing models is currently available. This information would be beneficial to help maximize optimal nurse staffing, identify how best-practice care can be promoted with tele-ICU, and promote best patient care outcomes.