Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.
J Crit Care. 2013 Dec;28(6):890-901. doi: 10.1016/j.jcrc.2013.05.008. Epub 2013 Jul 30.
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.
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.
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.
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.
我们进行了一项评估，以确定与重症监护病房（ICU）工作人员在实施前和实施后阶段接受远程 ICU（Tele-ICU）计划相关的因素。
对退伍军人事务部中西部医疗保健网络 Tele-ICU 和附属 ICU 的工作人员进行了个人或小组半结构化访谈和现场观察。对实施前和实施后的转录本和现场记录进行定性内容分析，以确定对 Tele-ICU 接受度有积极和消极影响的主题。
远程医疗 ICU 培训、Tele-ICU 理解、感知需求和组织因素在实施前成为影响 Tele-ICU 接受度的因素。实施后，Tele-ICU 理解、对工作系统的影响、感知有用性和关系成为影响接受度和利用度的因素。实施的障碍包括对如何使用 Tele-ICU 的困惑、沟通和工作流程的中断、期望未得到满足以及对被监控的不适。促进因素包括积极的体验、发现新的益处以及认识到 Tele-ICU 工作人员是床边护理的补充。
远程医疗 ICU 的实施是复杂的。应该为本地协调、持续的 Tele-ICU 支持需求评估、员工培训、建立人际关系以及系统设计和评估分配时间和资源。这些努力可能会得到回报，即工作人员更快地接受这项新技术。
