[Show abstract][Hide abstract] ABSTRACT: To measure teamwork and safety climate in three intensive care units (ICUs) before and after remote monitoring by intensivists using telemedicine technology (tele-ICU).
Controlled pre tele-ICU and post tele-ICU cross-sectional survey.
ICUs in two non-teaching community hospitals and one tertiary care teaching hospital. Subjects ICU physicians and nurses.
Remote monitoring of ICU patients by intensivists.
Teamwork Climate Scale (TWS), a Safety Climate Score (SCS) and survey items related to tele-ICU.
The mean (SD) teamwork climate score was 69.7 (25.3) and 78.8 (17.2), pre and post tele-ICU (p = 0.009). The mean SCS score was 66.4 (24.6) and 73.4 (18.5), pre and post tele-ICU (p = 0.045). While SCS scores within the ICUs improved, the overall SCS scores for these hospitals decreased from 69.0 to 65.4. Three of the non-scaled items were significantly different pre and post tele-ICU at p<0.001. The item means (SD) pre and post tele-ICU were: "others interrupt my work to tell me something about my patient that I already know" 2.5 (1.2) and 1.6 (1.3); "I am confident that my patients are adequately covered when I am off the unit" 3.2 (1.3) and 4.2 (1.1); and "I can reach a physician in an urgent situation in a timely manner" 3.8 (1.2) and 4.6 (0.6).
Implementation of a tele-ICU was associated with improved teamwork climate and safety climate in some ICUs, especially among nurses. Providers were also more confident about patient coverage and physician accessibility, and did not report unnecessary interruptions.
Quality and Safety in Health Care 12/2010; 19(6):e39. DOI:10.1136/qshc.2007.024992 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate workflow in intensive care unit remote monitoring, a technology-driven practice that allows critical care specialists to perform proactive and continuous patient care from a remote site.
A time-and-motion study.
Facility that remotely monitored 132 beds in nine intensive care units.
Six physicians and seven registered nurses.
Participants were observed for 47 and 39 hrs, respectively.
Clinicians' workflow was analyzed as goal-oriented tasks and activities. Major variables of interest included the times spent on different types of tasks and activities, the frequencies of accessing various information resources, and the occurrence and management of interruptions in workflow. Physicians spent 70%, 3%, 3%, and 24% of their time on patient monitoring, collaboration, system maintenance, and administrative/social/personal tasks, respectively. For nurses, the time allocations were 46%, 3%, 4%, and 17%, respectively. Nurses spent another 30% of their time maintaining health records. In monitoring patients, physicians spent more percentage times communicating with others than the nurses (13% vs. 7%, p = .026) and accessed the in-unit clinical information system more frequently (42 vs. 14 times per hour, p = .027), while nurses spent more percentage times monitoring real-time vitals (16% vs. 2%, p = .012). Physicians' and nurses' workflows were interrupted at a rate of 2.2 and 7.5 times per hour (p < .001), with an average duration of 101 and 45 secs, respectively (p = .006). The sources of interruptions were significantly different for physicians and nurses (p < .001).
Physicians' and nurses' task performance and information utilization reflect the distributed nature of work organization in intensive care unit remote monitoring. Workflow interruption, clinical information system usability, and collaboration with bedside caregivers are the major issues that may affect the quality and efficiency of clinicians' work in this particular critical care setting.
Critical Care Medicine 10/2007; 35(9):2057-63. DOI:10.1097/01.CCM.0000281516.84767.96 · 6.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Utilizing advanced information technology, Intensive Care Unit (ICU) remote monitoring allows highly trained specialists to oversee a large number of patients at multiple sites on a continuous basis. In the current research, we conducted a time-motion study of registered nurses' work in an ICU remote monitoring facility. Data were collected on seven nurses through 40 hours of observation. The results showed that nurses' essential tasks were centered on three themes: monitoring patients, maintaining patients' health records, and managing technology use. In monitoring patients, nurses spent 52% of the time assimilating information embedded in a clinical information system and 15% on monitoring live vitals. System-generated alerts frequently interrupted nurses in their task performance and redirected them to manage suddenly appearing events. These findings provide insight into nurses' workflow in a new, technology-driven critical care setting and have important implications for system design, work engineering, and personnel selection and training.
[Show abstract][Hide abstract] ABSTRACT: Critical care nurses can be instrumental in developing and implementing changes to improve patient safety. Targeted interventions, based on nurse-identified issues, can yield measurable results. There were several keys to engaging and sustaining nurses in this effort. Leaders at all levels of the organization consistently demonstrated their enthusiasm and support for every aspect of the initiative. Topics addressed-clarification of orders, establishing care protocols, strengthening chain of command, improving staff levels and staff education, and eliminating the overflow of nonspecialty patients to specialty units-arose from suggestions made by nurses through formal surveys, informal focus groups, clinical practice groups, or root cause analyses. Progress is measured, and feedback is frequent. The culture remains one of collaboration and continuous problem solving with nurses viewed as central to the process.
Critical Care Nursing Clinics of North America 01/2003; 14(4):341-6. DOI:10.1016/S0899-5885(02)00034-5 · 0.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Valuable lessons can be learned from the emergent evacuation of a large urban teaching hospital because of flooding.
Four hundred fifty-bed adult and 150-bed children's tertiary referral teaching hospital.
Massive rainfall from tropical storm Allison caused extensive flooding. Emergency power came on at 1:40 AM. Complete power loss occurred at 3:30 AM. The decision to begin evacuation of patients was made at approximately 10:30 AM. All 575 patients were either discharged from the hospital (169 patients) or evacuated (406 patients) to 29 other facilities by both ambulance and helicopter by 3 PM the next day. Six deaths occurred, none of which could be attributed to the conditions created by the flooding.
The lessons learned from this experience included the following: (1) flooding will occur in a flood plain; (2) electrical power outages are not necessarily temporary-begin evacuation; (3) appoint a triage officer from those available; (4) have a reliable in-house communication system not dependent on telephone lines or electricity; (5) have a reliable telephone system for contacting outside facilities; (6) have flashlights available on all units; (7) have battery-operated exit signs and stairway lights; (8) maximize use of volunteers when they are available and fresh; (9) maintain a paper record of all patient transfers; (10) coordinate loading of ambulances and helicopters for patient transfer; and (11) reassign staff as necessary to care for transferred patients. Emergent evacuation of a large, tertiary hospital requires extensive effort from both the hospital staff and the community.
Archives of Surgery 11/2002; 137(10):1141-5. DOI:10.1001/archsurg.137.10.1141 · 4.93 Impact Factor