To remain at the forefront of expanding evidence-based practices in all aspects of critical care, facilities must include teleICUs.
In 2013, the American Association of Critical-Care Nurses (AACN) first defined standards for the emerging telenursing practice in the ICU and has recently published an update, AACN TeleICU Nursing Practice: An Expert Consensus Statement Supporting High Acuity, Progressive and Critical Care.1
The new consensus statement, which creates a framework for implementing, evaluating, and improving teleICU nursing practice, addresses the new findings in this fast-growing area of health care. It also establishes a model for achieving excellence and optimal patient care outcomes through the following:
• Shared knowledge and goals
• Mutual respect
• Skilled communication
• True collaboration
• Authentic leadership
• Optimized technology
• Practice excellence
A 12-person task force, including teleICU nurse leaders, contributed to the statement and brought a fresh perspective to this area of practice.
Task force co-chair Pat Herr, clinical integration director of eCARE ICU at Avera Health, says it was important to harness the energy and lessons learned from experienced teleICU leaders.
“TeleICUs continue to evolve to meet the needs of patients and health systems,” Herr adds. “New technology options and new partnership models are available, and nurse leaders play an important part in using these tools to improve patient care.”
The earliest teleICU design concepts employed a physician-only model of care, but it quickly became clear that critical-care nursing was a necessary component. Today, the most effective teleICU models implement collaborative care that includes physicians, nurses, information technology, and administrative support personnel.Opportunities in teleICU are one way to retain knowledgeable nurses, who can bridge clinical expertise gaps and provide an additional layer of skilled critical care. TeleICU care ensures delivery of both optimal patient outcomes and timely knowledge to support physicians, nurses, and the entire bedside care team.
Task force member Lisa-Mae Williams, operations director of telehealth and eICU at Baptist Health South Florida, says telemedicine doesn’t mean fewer jobs for bedside nurses; it’s an extra set of eyes to surveil vitals and support a clinical workforce that may be stretched thin.
“At the bedside, when teleICU came to my unit, I was very skeptical,” Williams recalls. “But after seeing for myself what those extra nurses brought to the table – the available technology and time they had to assess trends and really delve into what’s going on – it turned out to be the best tool to care for our patients.”
In addition to knowledge gaps, nurse turnover is on the rise, according to the “2017 Survey of Registered Nurses: Viewpoints on Leadership, Nursing, Shortages and Their Profession” from AMN Healthcare, San Diego.2 The survey also finds that more than one in four nurses plan to retire within a year, and 73% of baby boomers expect to retire in 3 years or less.
The shortfall is already more pronounced in rural hospitals facing staffing challenges and in specialty areas where additional education, training, and experience are critical to improve patient safety and outcomes.
The expertise and dynamic, front-line viewpoint of teleICU experts has resulted in a comprehensive, patient-centric update. Their experience delivering both bedside and remote care was instrumental in developing valuable clinical scenarios. The scenarios in the statement are genuine examples of how each key recommendation is implemented by physicians and bedside and teleICU nurses to provide continuity of care; identify high-risk patients; and decrease mortality rates by filling gaps in monitoring and staff expertise.