Nurses: Communication, personal relationships key to eICU success

Telehealth visits might be virtual, but to be most effective they also should be personal, critical care nurses said in a recent survey published in the American Journal of Critical Care.

Most nurses (72 percent) said they think telemedicine increases patients' survival. But the majority (79 percent) also said they thought that personally knowing the telemedicine physician was important and 61 percent said they were more likely to contact the telemedicine unit if they knew the physician on call.

The survey was conducted at the University of Pennsylvania Health System, which operates an ICU telemedicine program (eICU) in three independently managed hospitals in Philadelphia.

The program uses the Philips Electronics VISICU eICU remote monitoring system to link the ICUs to an offsite central monitoring facility. It includes two-way audio conferencing, one-way video conferencing that allows the telemedicine team to view activity in a patient's room, an electronic medical record available to both the telemedicine and bedside clinicians, and continuous physiological monitoring that can detect trends in vital signs and laboratory values and alert the telemedicine staff. Telemedicine physicians also have access to radiology exams and continuous telemetry through separate electronic systems.

Among the 93 survey respondents, contact with the telemedicine unit was relatively infrequent, according to the survey. About a third (31 percent) reported being called by the unit three or more times in the preceding six months.

But nurses were positive about the interactions they did have: 82 percent said they were confident in the telemedicine staff's recommendations and 44 percent reported regularly incorporating suggested interventions.

Negative reactions among the group were relatively minor. Only 9 percent said telemedicine interrupted work flow and 11 percent called it intrusive. Slightly more (13 percent) said telemedicine interactions give them a sense of being spied upon.

Patient privacy was a bigger concern. Almost all nurses (87 percent) said telemedicine staff should alert the bedside nurse when "entering" a patient's room.

"Practicing bedside nurses with experience in telemedicine generally support its use, but concerns about privacy issues and the desire to personally know the telemedicine physician may hinder broader application of the technology," the authors write.

They add that communication and listening to nurses--who have strong opinions about virtual visit protocols--can improve telemedicine programs.

"Managing communication between physicians and nurses is an important challenge to all intensive care," the authors write. "These issues are compounded in telemedicine programs in which off-site physicians, on-site physicians, and bedside nurses must efficiently coordinate complex care for critically ill patients. Our findings indicate that time invested in creating personal relationships between bedside nurses and telemedicine staff and communicating care plans with all in-house clinicians most likely will affect satisfaction with an ICU telemedicine program."

To learn more:
- read the study abstract 

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