The roles of the tele-ICU technology in quality of care and patient safety of intensive care units

The tele-ICU technology may be a means to improve the development and use of critical care resources. Studies have evaluated the effects of tele-ICU technology on ICU patient outcomes, but the results have been conflicting. This research focuses on understanding the roles of the tele-ICU technology in contributing to ICU care processes and patient outcomes.;Semi-structured interviews were conducted with 61 tele-ICU managers, physicians, and nurses from 5 tele-ICUs to obtain their perspective on the roles of the tele-ICU technology in contributing to patient outcomes. Interviews were audio recorded and transcribed. Content analysis was performed by two researchers using the SEIPS model as a framework.;We identified a total of 29 tele-ICU mechanisms (19 positive mechanisms; 10 negative/neutral mechanisms) that can impact care processes and patient outcomes. Mechanisms perceived to improve care processes and patient outcomes include: tele-ICU providing extra resources, tele-ICU as a quality trigger for improvement activities in the ICUs, tele-ICU technology (i.e. alarm/alert and camera) detecting signs of patient deterioration, and tele-ICU's contribution to medication management. We found that availability of extra resources had an impact on mortality and LOS, tele-ICU as a quality trigger can improve evidence-based medicine compliance, use of tele-ICU alarm and camera helps with patient falls and extubations, and tele- ICU assisting in medication management can improve medication safety, mortality and LOS. On the other hand, the tele-ICU technology is perceived to impact ICU care processes and patient outcomes negatively when tele-ICU physicians and nurses lack patient-related information. Tele-ICU physicians may provide poor care decisions leading to medication errors. We found that the tele-ICU technology is perceived to have no impact on patient care processes and outcomes when the tele-ICU is not being accepted and utilized by ICU staff.;In conclusion, tele-ICU managers, physicians and nurses provided information on different ways that the tele-ICU technology can influence various patient care processes and outcomes both positively and negatively.