Problem to be Resolved:
One emerging model of care delivery in the critical care setting is ICU remote monitoring. Use of the Internet and specialized hardware and software enables intensivists and critical care nurses to identify early changes in the patients' physiological condition and assist or direct management of care. Because this model is new, the impact of interventions is not well understood.
Objectives of the Project:
The purpose of this project was to investigate interventions made by the clinicians monitoring patients remotely and evaluate the impact of these interventions on patient outcomes, professional practice, and organizational processes.
Methods:
An electronic data collection tool was designed for use by telemedicine nurses to document interventions and outcomes at the point of care. Intervention is defined as any action that prompts communication between the remote ICU and the bedside caregiver.
Outcomes:
Interventions are classified into three categories: physiological, patient safety, and facilitative. Triggers for interventions were received from the software program 77% of the time. The trigger source correlates with most of the interventions being made in the physiological category (81%). Safety interventions (5%) included increased observation of confused patients and recovery of alarms.
Lessons Learned:
Evaluation of the interventions prompted changes to the workflow of the telemedicine nurse. The availability of a point of intervention tool has yielded a large increase in documented interventions, supporting the need for additional staffing. Interventions made by telemedicine nurses have contributed to an overall decrease in ICU length of stay and mortality throughout the organization.
Section Description
We are pleased to share the paper presentation abstracts from the Summer Institute in Nursing Informatics, Informatics at the Point of Care: A Barrier or a Bridge?, held at the University of Maryland School of Nursing, July 22 to 25, 2009. The program, chaired by Dr Judy Ozbolt, was a great success. Each of the following abstracts was selected for presentation by a peer-review committee.