The electronic intensive care unit: Eyes in the sky
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This ethnographic study of the VISICU eICU® (Baltimore, MD) work environment in a large Midwestern healthcare system describes everyday life working in a telemedicine intensive care. The eICU® telemedicine model of care uses technology to provide intensivist-driven care in settings without bedside intensivist coverage. Previous studies of the eICU® model of care mainly focus on quantitative elements evaluating specific clinical outcomes. This study examined the way such units function. Data were gathered through 60 hours of observation and formal interviews of eClinician team members. Thirteen eNurses, three ePhysicians, and one IT Systems Analyst participated in semi-structured interviews and twenty-seven additional eClinicians participated in the field study. Years of clinical experience and experience in critical care ranged from 5 years to over 30 years. Findings concluded that the eICU® work environment is like working in an air traffic control center. eClinicians work at computer screens monitoring multiple ICU patients. The eClinician has access to information that is not always readily available to the bedside team. The eClinician provides this information and recommendations for interactions to the bedside team who has hands-on control to change the course of events. Effective communication and interactions between the eClinicians and the bedside team are critical to the success of this practice model. The eICU® model of care is a viable way to provide experienced ICU nurses and intensivists to supplement the bedside team. The work environment provides a way for eNurses to continue to use their critical thinking skills and ICU experience in a setting with less physical demands than bedside ICU nursing. The ePhysicians find value in the eICU® model of care from a patient safety and cost avoidance perspective but admit that the ideal care model includes an intensivist at the bedside. Further study is needed to describe the eICU® care model from the perspective of the bedside ICU team. This perspective is needed in order to determine how to develop appropriate protocols, policies, communication plans, and practices that will ensure ongoing effective collaboration between the two entities.