Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety.

The deployment of remote monitoring of intensive care unit (ICU) patients, known as tele-ICU technology, promotes the efficient use of critical care resources. Although tele-ICU use has spread rapidly, the benefits vary widely among studies, and little is known about the specific characteristics of tele-ICU that provide benefits to patient care. The purpose of this study was to identify aspects of tele-ICU that contribute, whether positively or negatively, to care processes and patient outcomes. This study was not aimed at evaluating the impact of tele-ICU on care outcomes. We conducted a qualitative study using semistructured interviews. Sixty-one tele-ICU staff from 5 tele-ICUs participated in the study. We performed inductive content analysis and coded 722 pieces of text into 19 positive and 9 negative/neutral tele-ICU contributions to care processes and patient outcomes. We found that availability of extra resources can reduce on mortality and length of stay, that a tele-ICU could serve as a quality trigger to improve evidence-based medicine compliance, that tele-ICU can support medication management and improve medication safety, and that tele-ICU software alerts and monitoring by camera can help reduce the risk of patient falls and extubations. We also found that tele-ICU physicians can make poor care decisions leading to medication errors if they lack patient-related information. Moreover, the tele-ICU has no impact on patient care processes and outcomes when the technology is not accepted and used by ICU staff.