title: Staff acceptance of a telemedicine intensive care unit program: a qualitative study.
abstract: OBJECTIVE
  We conducted an evaluation to identify factors related to intensive care unit (ICU) staff acceptance of a telemedicine ICU (Tele-ICU) program in preimplementation and postimplementation phases.
  
  
  METHODS
  Individual or group semistructured interviews and site observations were conducted with staff from the Veterans Affairs Midwest Health Care Network Tele-ICU and affiliated ICUs. A qualitative content analysis of preimplementation and postimplementation transcripts and field notes was undertaken to identify themes positively and negatively influencing Tele-ICU acceptance.
  
  
  RESULTS
  Telemedicine ICU training, Tele-ICU understanding, perceived need, and organizational factors emerged as influencing acceptance of the Tele-ICU before implementation. After implementation, Tele-ICU understanding, impact on work systems, perceived usefulness, and relationships were factors influencing acceptance and utilization. Barriers to implementation included confusion about how to use the Tele-ICU, disruptions to communication and workflows, unmet expectations, and discomfort with being monitored. Facilitators included positive experiences, discovery of new benefits, and recognition of Tele-ICU staff as complementing bedside care.
  
  
  CONCLUSIONS
  Telemedicine ICU implementation is complex. Time and resources should be allocated for local coordination, continuous needs assessment for Tele-ICU support, staff training, developing interpersonal relationships, and systems design and evaluation. Such efforts are likely to be rewarded with more rapid staff acceptance of this new technology.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA. Electronic address: Jane.Moeckli@va.gov.
authors.forename: Jane
authors.initials: J
authors.lastname: Moeckli
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.forename: Cassie
authors.initials: C
authors.lastname: Cunningham
authors.forename: Heather Schacht
authors.initials: HS
authors.lastname: Reisinger
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D008297:Male; D061214:Patient Safety; D036301:Qualitative Research; D011787:Quality of Health Care; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States
keywords: Attitude of health personnel; Implementation; Telemedicine intensive care unit