Acceptability of Tele-Critical Care Consultation for Patients at Risk of ICU Admission

Current approaches for bringing critical care expertise to hospital floors to support deteriorating patients are limited by intensivist availability, costs, and scalability. Using existing tele-critical care clinicians to perform consultations on deteriorating patients at risk for ICU admission may overcome these limitations.

To characterize clinician perspectives on tele-critical care consultation during an initial small-scale implementation.

An on-demand tele-critical care consultation service was implemented on selected medical and surgical floors at a large academic medical center, with options for tele-intensivist recommendations only, time-limited monitoring by tele-nurses ± intensivist co-management, or assistance with immediate ICU transfer. To characterize perspectives of both bedside and telemedicine physicians and nurses who participated in consultations, a survey including the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure was performed. Some clinicians also participated in semi-structured interviews.

Each survey component was described using median and interquartile range. Interviews were transcribed and analyzed using a thematic analysis approach. Open coding was performed independently by two investigators, followed by identification of themes and iterative team discussion until consensus was reached.

Over 1 year, 65 consultations were performed. Across 43 surveys, the median score was 4 of 5 for each of the validated measures. In the 12 interviews, consistently positive themes included excellent quality of care, support for night shift, and reassurance to patients and families. Themes with mixed feedback included effectiveness in time-critical situations, impact on clinician workload, and communication and collaboration between teams. Opportunities for improvement included increased awareness, issues related to mobile carts, and expansion throughout the hospital.

Telemedicine can be used to deliver critical care consultations to hospitalized floor patients who are deteriorating. Bedside and telemedicine clinicians were highly satisfied with the consultation service.