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Organizational and Teamwork Factors of Tele-Intensive Care Units
Michael S Wilkes1, James P Marcin2, Lois A Ritter1
1Michael S. Wilkes is a professor, Department of Internal Medicine and director of Global Health, and James P. Marcin is a professor and division chief, Pediatric Critical Care, Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California. Lois A. Ritter is a research manager, WRMA Inc, Sacramento, California. Sherilyn Pruitt is director, Office of Programs and Engagement in the Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Washington, DC.
Background:
Use of tele-intensive care involves organizational and teamwork factors across geographic locations. This situation adds to the complexity of collaboration in providing quality patient-centered care.
Objective:
To evaluate cross-agency teamwork of health care professionals caring for patients in tele-intensive care units in rural and urban regions.
Methods:
A national qualitative study was conducted in 3 US geographic regions with tele-intensive care programs. Discussions and interviews were held with key participants during site visits at 3 hub sites (specialist services location) and 8 rural spoke sites (patient location). The effects of communication and culture between the hub team and the spoke team on use of the services and effectiveness of care were evaluated.
Results:
A total of 34 participants were interviewed. Specific organizational and teamwork factors significantly affect the functionality of a tele-intensive care unit. Key operational and cultural barriers that limit the benefits of the units include unrealistic expectations about operational capabilities, lack of trust, poorly defined leadership, and a lack of communication policies. Potential solutions include education on spoke facility resources, clearly defined expectations and role reversal education, team-building activities, and feedback mechanisms to share concerns, successes, and suggestions.
Conclusion:
Proper administration and attention to important cultural and teamwork factors are essential to making tele-intensive care units effective, practical, and sustainable.
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