Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers

BackgroundOur study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during inter...

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Main Authors: Krzysztof Laudanski, Ann Marie Huffenberger, Michael J. Scott, Maria Williams, Justin Wain, Juliane Jablonski, C. William Hanson
Format: Article
Language:English
Published: Frontiers Media S.A. 2022-08-01
Series:Frontiers in Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2022.883126/full
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author Krzysztof Laudanski
Krzysztof Laudanski
Krzysztof Laudanski
Ann Marie Huffenberger
Michael J. Scott
Michael J. Scott
Maria Williams
Justin Wain
Juliane Jablonski
C. William Hanson
C. William Hanson
author_facet Krzysztof Laudanski
Krzysztof Laudanski
Krzysztof Laudanski
Ann Marie Huffenberger
Michael J. Scott
Michael J. Scott
Maria Williams
Justin Wain
Juliane Jablonski
C. William Hanson
C. William Hanson
author_sort Krzysztof Laudanski
collection DOAJ
description BackgroundOur study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during interactions with the bedside team have not been characterized systematically. These characteristics are critical for planning the deployment of teleICU services and preventing burnout among remote teleICU providers.MethodsREDCap self-reported activity logs collected engagement duration, triggers (emergency button, tele-CCM software platform, autonomous algorithm, asymmetrical communication platform, phone), expediency, nature (proactive rounding, predetermined task, response to medical needs), communication modes, and acceptance. Seven hospitals with 16 ICUs were overseen between 9/2020 and 9/2021 by teams consisting of telemedicine medical doctors (eMD), telemedicine registered nurses (eRN), and telemedicine respiratory therapists (eRT).Results39,915 total engagements were registered. eMDs had a significantly higher percentage of emergent and urgent engagements (31.9%) vs. eRN (9.8%) or eRT (1.7%). The average tele-CCM intervention took 16.1 ± 10.39 min for eMD, 18.1 ± 16.23 for eRN, and 8.2 ± 4.98 min for eRT, significantly varied between engagement, and expediency, hospitals, and ICUs types. During the observation period, there was a shift in intervention triggers with an increase in autonomous algorithmic ARDS detection concomitant with predominant utilization of asynchronous communication, phone engagements, and the tele-CCM module of electronic medical records at the expense of the share of proactive rounding. eRT communicated more frequently with bedside staff (% MD = 37.8%; % RN = 36.8, % RT = 49.0%) but mostly with other eRTs. In contrast, the eMD communicated with all ICU stakeholders while the eRN communicated chiefly with other RN and house staff at the patient's bedside. The rate of distress reported by tele-CCM staff was 2% among all interactions, with the entity hospital being the dominant factor.ConclusionsDelivery of tele-CCM services has to be tailored to the specific beneficiary of tele-CCM services to optimize care delivery and minimize distress. In addition, the duration of the average intervention must be considered while creating an efficient workflow.
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spelling doaj.art-f6888fa3e42d41f5a4ba90dd840bb4c82022-12-22T00:54:27ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-08-01910.3389/fmed.2022.883126883126Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providersKrzysztof Laudanski0Krzysztof Laudanski1Krzysztof Laudanski2Ann Marie Huffenberger3Michael J. Scott4Michael J. Scott5Maria Williams6Justin Wain7Juliane Jablonski8C. William Hanson9C. William Hanson10Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesLeonard Davis Institute for Healthcare Economics, Philadelphia, PA, United StatesDepartment of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesPenn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesDepartment of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesPenn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesPenn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesCampbell University School of Osteopathic Medicine, Lillington, NC, United StatesUniversity of Pennsylvania Health System, Philadelphia, PA, United StatesDepartment of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesPenn Medicine Center for Connected Care, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesBackgroundOur study addresses the gaps in knowledge of the characterizations of operations by remote tele-critical care medicine (tele-CCM) service providers interacting with the bedside team. The duration of engagements, the evolution of the tele-CCM service over time, and the distress during interactions with the bedside team have not been characterized systematically. These characteristics are critical for planning the deployment of teleICU services and preventing burnout among remote teleICU providers.MethodsREDCap self-reported activity logs collected engagement duration, triggers (emergency button, tele-CCM software platform, autonomous algorithm, asymmetrical communication platform, phone), expediency, nature (proactive rounding, predetermined task, response to medical needs), communication modes, and acceptance. Seven hospitals with 16 ICUs were overseen between 9/2020 and 9/2021 by teams consisting of telemedicine medical doctors (eMD), telemedicine registered nurses (eRN), and telemedicine respiratory therapists (eRT).Results39,915 total engagements were registered. eMDs had a significantly higher percentage of emergent and urgent engagements (31.9%) vs. eRN (9.8%) or eRT (1.7%). The average tele-CCM intervention took 16.1 ± 10.39 min for eMD, 18.1 ± 16.23 for eRN, and 8.2 ± 4.98 min for eRT, significantly varied between engagement, and expediency, hospitals, and ICUs types. During the observation period, there was a shift in intervention triggers with an increase in autonomous algorithmic ARDS detection concomitant with predominant utilization of asynchronous communication, phone engagements, and the tele-CCM module of electronic medical records at the expense of the share of proactive rounding. eRT communicated more frequently with bedside staff (% MD = 37.8%; % RN = 36.8, % RT = 49.0%) but mostly with other eRTs. In contrast, the eMD communicated with all ICU stakeholders while the eRN communicated chiefly with other RN and house staff at the patient's bedside. The rate of distress reported by tele-CCM staff was 2% among all interactions, with the entity hospital being the dominant factor.ConclusionsDelivery of tele-CCM services has to be tailored to the specific beneficiary of tele-CCM services to optimize care delivery and minimize distress. In addition, the duration of the average intervention must be considered while creating an efficient workflow.https://www.frontiersin.org/articles/10.3389/fmed.2022.883126/fulltele-ICUtele-CCMcritical careworkflowcommunicationintensive care unit
spellingShingle Krzysztof Laudanski
Krzysztof Laudanski
Krzysztof Laudanski
Ann Marie Huffenberger
Michael J. Scott
Michael J. Scott
Maria Williams
Justin Wain
Juliane Jablonski
C. William Hanson
C. William Hanson
Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
Frontiers in Medicine
tele-ICU
tele-CCM
critical care
workflow
communication
intensive care unit
title Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
title_full Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
title_fullStr Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
title_full_unstemmed Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
title_short Operation analysis of the tele-critical care service demonstrates value delivery, service adaptation over time, and distress among tele-providers
title_sort operation analysis of the tele critical care service demonstrates value delivery service adaptation over time and distress among tele providers
topic tele-ICU
tele-CCM
critical care
workflow
communication
intensive care unit
url https://www.frontiersin.org/articles/10.3389/fmed.2022.883126/full
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