Bedside Critical Care Staff Use of Intensive Care Unit Telemedicine: Comparisons by Intensive Care Unit Complexity

Background: Effects of Intensive Care Unit (ICU) telemedicine on patient and staff outcomes are mixed. Variation in utilization is potentially driving these differences. Introduction: 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. Materials and Methods: 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). Results: 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. Discussion: 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. Conclusions: 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.