Nurses' Perceptions of Telemedicine Adoptionin the Intensive Care Unit

Roberta Kaplow, PhD, APRN-CCNS, AOCNS, CCRN; Mary Zellinger, MN, RN, ANP-BC, CCRN-CSC, CCNS

Disclosures

Am J Crit Care. 2021;30(2):122-127. 

In This Article

Abstract and Introduction

Abstract

Background: With telemedicine technology, off-site expert clinicians can consult in real time with bedside nurses and providers. The success of telemedicine may depend on its acceptance by bedside nurses and providers.

Objectives: To compare nurses' perceptions of telemedicine in 2 intensive care units (ICUs) at Emory University Hospital, an academic medical center, and to determine the relation between nurses' years of ICU experience and their perceptions of telemedicine in the hospital's ICUs (Emory e-ICU Center).

Methods: This study used a descriptive correlational design. Nurses in the 2 units completed a demographic form and a questionnaire about their perceptions of the Emory e-ICU Center.

Results: A total of 60 participants completed the study (30 nurses from each unit). Among the entire sample, the perception scores ranged from 2.4 to 5.0, with a mean score of 3.8 (SD, 0.6). Perception scores were significantly higher for nurses in the acute respiratory ICU than for those in the cardiovascular ICU; nurses in the acute respiratory ICU had spent less time working in an ICU. No statistically significant correlation was found between nurses' years of experience in an ICU and their perception scores. This correlation was also not significant within each unit. Nurses' experience with telemedicine in the ICU also did not correlate significantly with perception scores.

Conclusions: Despite differences in nurses' years of experience, the perceptions of the Emory e-ICU Center did not differ significantly among nurses.

Introduction

Telemedicine is defined as "the use of medical information exchanged from one site to another via electronic communications to improve patients' health status."[1] Its most basic form dates back to the 1970s. With such technology, off-site expert clinicians can consult in real time with bedside nurses and providers (nurse practitioners and physician assistants), observing patients for changes in vital sign trends and early signs of clinical deterioration.[2–7]

The use of telemedicine has expanded to intensive care units (ICUs), where additional surveillance and support are available for bedside nurses and providers. When applied to an ICU, the telehealth care model is referred to as "tele-ICU" and allows expert critical care nurses and physicians to provide continuous surveillance, monitoring, and patient care.[8] Tele-ICU was originally designed to assist in the management of critically ill patients in locations where access to ICU beds and trained intensivists is limited.[9] The main focus of tele-ICU is management of and intervention during critical events.[4] Within the Emory Healthcare system, the program is referred to as the Emory e-ICU Center, and its main focus is to support staff by providing surveillance of patients, assisting remotely with critical events, and determining data trends to help identify clinical decompensation early.

Nurses' and providers' perceptions of telemedicine have been evaluated before.[3,8,10–13] Mullen-Fortino et al[10] reported that clinicians had infrequent contact with telemedicine: 31% of nurses and clinicians reported contact with telemedicine staff 3 or 4 times during the preceding 6 months. Most nurses (72%) believed that use of telemedicine improved patient survival, and 44% reported implementing the interventions recommended by telemedicine staff. Only 47% of the nurses and clinicians believed that telemedicine prevented medical errors, and just 42% thought it augmented patient satisfaction scores. More than half (61%) of nurses reported that they were more likely to notify the telemedicine staff if they knew the physician who was on call. A small percentage (9%) perceived telemedicine to interrupt their workflow, and 11% thought it was intrusive. The intrusiveness of telemedicine has been corroborated.[8]

A systematic review and meta-analysis substantiated an association between a lower mortality rate and patients who receive care via telemedicine, and it revealed significantly shorter ICU and hospital lengths of stay among such patients.[14] Other benefits of telemedicine in the ICU reported by nurses include increased adherence to evidence-based care[4] and improved perception of support at the bedside.[15] Becevic et al[3] corroborated positive perceptions of telemedicine among clinicians and reported improved communication and patient care.

Kleinpell et al[8] reported that 63% of ICU nurses perceived telemedicine to assist them in completing tasks more quickly, almost 66% believed that the technology augmented collaboration, more than 63% thought it improved their job performance, and more than 60% believed it improved communication. More than 45% of the nurses believed that telemedicine improved patient care by giving them more time to provide it. Kleinpell et al reported the benefits of telemedicine to include an ability to note trends in patients' vital signs, detect patient instability, provide medical management, and augment patient safety. They also noted barriers, however, including some related to technology, nurse attitudes, and interruptions to care. Some nurses perceived telemedicine to be an interference.

We found only 1 report that compared differences in perceptions of telemedicine between nurse groups. Replicating the aforementioned 2012 study by Mullen-Fortino et al,[10] who reported perceptions of telemedicine among nurses working in an urban setting, Parker[11] investigated perceptions of nurses in rural settings. (Parker conducted this study in partial fulfillment of a master's thesis in 2016.) Parker corroborated the findings of Mullen-Fortino et al, determining that telemedicine improves collaboration, communication, and patient outcomes.

Wicklund[13] reported data from a survey conducted by the Center for Clinical Research at Rush University Medical Center. In that survey, nurses from 45 units nationwide agreed that telemedicine technology improved collaboration and job performance and increased their ability to accomplish their work more quickly. More than 6000 patients in more than 200 hospitals (approximately 12% of patients in ICUs in the United States) were being monitored via telemedicine at the time of the survey. A reported barrier was the attitudes of ICU staff, more than 40% of whom perceived telemedicine technology as an "interference." Approximately 23% of those who participated in the survey reported attitudes of the telemedicine staff and "collegial respect" as barriers.

The success of telemedicine may depend on its acceptance by bedside nurses and providers.[11] Therefore, the purpose of this study was to compare perceptions of telemedicine (in this case, the Emory e-ICU Center) between nurses in 2 ICUs at Emory University Hospital. The acute respiratory ICU (ARICU) is currently staffed primarily with nurses who are new to critical care (ie, they have only medical-surgical experience). In 2018, hospital leadership deemed it necessary to open additional ICU beds at Emory University Hospital. Although they sought nurses who were experienced in critical care, they received very few immediate responses. Therefore, the hospital implemented a special orientation to develop the competencies of the medical-surgical nurses who applied. Nurses were oriented within already existing ICUs, where ICU nurses experienced in those areas served as preceptors. The second unit, the cardiovascular surgery ICU (CVICU), is staffed primarily with nurses who have between 5 and 30 or more years of ICU experience.

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