Bedside Critical Care Staff Use of Intensive Care Unit Telemedicine: Comparisons by Intensive Care Unit Complexity.
Effects of Intensive Care Unit (ICU) telemedicine on patient and staff outcomes are mixed. Variation in utilization is potentially driving these differences.



ICU telemedicine utilization is understudied, with existing research focusing on telemedicine staff. We assess ICU telemedicine utilization from the perspective of the end user-ICU staff-to better understand how telemedicine use is conceptualized and practiced at the bedside.



We conducted a thematic content analysis of semistructured interviews with bedside ICU staff. Staff were interviewed at seven ICUs in six Veterans Health Administration facilities, representing varying ICU complexities and points in time (2 and 12 months postimplementation of ICU telemedicine).



Fifty-eight bedside ICU staff described instances of telemedicine use, which were categorized into three types: Urgent ICU Patient Care, Clinical Decision-Making and Support, and General ICU Patient Care. The most commonly described use was General ICU Patient Care and the least common was Urgent ICU Patient Care. ICU staff from lower complexity ICUs had fewer descriptions of use compared to staff at higher complexity ICUs. At 12 months postimplementation, staff recounted more instances of all three utilization types.



It is important to understand how telemedicine is being used within ICUs to evaluate its impact. The presence of three types of use, variability in use by ICU complexity, and change in use over time suggest the need for comprehensive measures of utilization to evaluate effectiveness.



ICU telemedicine needs to develop an agreed upon typology for documenting ICU telemedicine utilization and incorporate these measures into models of its effect on clinical outcomes.
1 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) , Iowa City VA Health Care System, Iowa City, Iowa.
Jonathan T
JT
Thomas
1 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) , Iowa City VA Health Care System, Iowa City, Iowa.|2 Veterans Rural Health Resource Center-Iowa City , Iowa City VA Health Care System, Iowa City, Iowa.
Jane
J
Moeckli
1 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) , Iowa City VA Health Care System, Iowa City, Iowa.|2 Veterans Rural Health Resource Center-Iowa City , Iowa City VA Health Care System, Iowa City, Iowa.|3 Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa.
Michelle A
MA
Mengeling
1 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) , Iowa City VA Health Care System, Iowa City, Iowa.|2 Veterans Rural Health Resource Center-Iowa City , Iowa City VA Health Care System, Iowa City, Iowa.
Cassie Cunningham
CC
Goedken
4 College of Nursing, University of Iowa , Iowa City, Iowa.
Jacinda
J
Bunch
5 University Health Network and Mount Sinai Hospital, University of Toronto , Toronto, Canada .
Peter
P
Cram
1 Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) , Iowa City VA Health Care System, Iowa City, Iowa.|2 Veterans Rural Health Resource Center-Iowa City , Iowa City VA Health Care System, Iowa City, Iowa.|3 Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa.
Heather Schacht
HS
Reisinger
D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods; D003422:Critical Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods; D010564:Personnel, Hospital; D036301:Qualitative Research; D017216:Telemedicine / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs
information management; policy; technology; telemedicine