Determinants of Intensive Care Unit Telemedicine Effectiveness. An Ethnographic Study

• DOI: 10.1164/rccm.201802-0259oc
• Publication Date: 2018-10-23T22:09:49Z
• Authors: Jeremy M. Kahn; Kimberly J. Rak; Courtney C. Kuza; Laura Ellen Ashcraft; Amber E. Barnato; Jessica C. Fleck; Tina B. Hershey; Marilyn Hravnak; Derek C. Angus
• Keywords: 2019-20 coronavirus outbreak

Rationale: Telemedicine is an increasingly common care delivery strategy in the ICU. However, ICU telemedicine programs vary widely their clinical effectiveness, with some studies showing a large mortality benefit and others no or even harm.Objectives: To identify organizational factors associated effectiveness.Methods: We performed focused ethnographic evaluation of 10 using site visits, interviews, focus groups both facilities providing remote target ICUs. Programs were selected based on change risk-adjusted after adoption (decreased mortality, increased mortality). used constant comparative approach to guide data collection analysis.Measurements Main Results: conducted 460 hours direct observation, 222 18 across six Data analysis revealed three domains that influence effectiveness: 1) leadership (i.e., decisions related role telemedicine, conflict resolution, relationship building), 2) perceived value expectations availability impact, staff satisfaction, understanding operations), 3) characteristics staffing models, allowed involvement unit, new hire orientation). In most effective these led services are viewed as appropriate, integrated, responsive, consistent.Conclusions: The effectiveness may be influenced by several potentially modifiable within leadership, value, structure.