Tele-ICU in Rural Hospitals: The Need for More Research
Telemedicine is the use of electronic communication technologies to provide clinical care, and Tele-ICU (also known as eICU) is the term used to describe telemedicine services provided to a remote intensive care unit (ICU). Telemedicine has demonstrated its ability to improve rural health care by increasing access to services and specialists, hence improving quality of care and health outcomes. While the amount of research on the effects of telemedicine on rural facilities is expanding, the research on the impact of Tele-ICU on rural facilities is limited. The reason is twofold: (1) many Tele-ICU programs provide services to large, more urban facilities, and (2) the common measures of success are often not the measures that reflect the impact of Tele-ICU on rural facilities.
It is for these reasons that there is a need for further study on the impact of Tele-ICUs on rural facilities. Because of number of ICU patients in rural facilities is so small, the typical indicators used for Tele-ICU studies, such as changes in length of stay and mortality, would not be useful when studying rural facilities. Qualitative research is needed on five domains: 1) clinical outcomes, 2) human factors, 3) cost effectiveness, 4) policy and program development, and 5) technology.
Recommended Methodology Guided discussions with professionals working at both the hub and the rural spoke sites would need to be conducted. The discussions would need to address each of the five study domains and be conducted with administrators, nurses, and physicians who are knowledgeable of ICU operations.
Separate Discussion Guides for the hub administrator, nurse, and physician as well as for the spoke administrator, nurse, and physician would be necessary. Participants would need to sign informed consent forms.
Some sample discussion topics are: Clinicians
A. CLINICAL OUTCOMES 1. Changes in quality of care that have occurred since Tele-ICU implementation. 2. How data are used to alter practice patterns and improve patient outcomes. 3. How Tele-ICU impacts the number and timing of patient transfers.
B. HUMAN FACTORS 1. How conflicts or disagreements in opinion are handled. 2. What helps or hinders communication between the two teams. 3. How communication between sites may have changed over time.
C. POLICY AND PROGRAM DEVELOPMENT 1. What internal policies have been developed since implementation. 2. What external policy changes are needed. 3. What policies are needed for expansion and sustainability.
D. TECHNOLOGY 1. What technological challenges have been experienced with Tele-ICU and how are they resolved. 2. Is proper and sufficient training provided to personnel on how to use the technology. 3. What interoperability challenges exist.
E. CLOSING 1. Overall, how Tele-ICU care is beneficial to patients and staff in remote rural facilities.
Administrator
A. CLINICAL OUTCOMES 1. How is Tele-ICU data is used to monitor employee performance and identify training needs.
B. COST EFFECTIVENESS 1. How Tele-ICU has impacted the organization financially. 2. How the costs of Tele-ICU offset.
C. HUMAN FACTORS 1. The impact of Tele-ICU on the reputation of the facility. 2. The impact of Tele-ICU on retention/recruitment of staff.
D. POLICY AND PROGRAM DEVELOPMENT 1. The internal and external policy development issues arose when implementing Tele-ICU. 2. The legal concerns that exist. 3. If Tele-ICU has impacted other departments within the facility.
E. TECHNOLOGY 1. The technological challenges that your organization experienced due to Tele-ICU. 2. The types of technical personnel and staff training needed. F. CLOSING 1. If Tele-ICU care has been beneficial to your facility and if the level of benefit has been reached in this system.
Summary More research is needed on the impact of Tele-ICUs on rural hospitals. Because quantitative data will not adequately capture the effects, guided discussions with administrators, nurses, and physicians working at the hub and spoke sites is recommended.
Submitted by Lois Ritter
