Mixed Methods Study of Tele-ICU Nursing Interventions to Prevent Failure to Rescue in the Critically Ill


Purpose: The purpose of this study is 1) to characterize tele-ICU nursing interventions related to the prevention of failure to rescue (FTR) through qualitative exploration, 2) to determine which combination of documented tele-ICU nursing interventions (DTNIs) best predicts prevention of FTR in patients with a diagnosed hospital acquired condition (HAC), 3) to triangulate qualitative and quantitative findings in order to provide a comprehensive understanding of tele-ICU nursing practice.

Background: Telemedicine Intensive Care Unit (tele-ICU) nursing is a dimension of critical care and requires clinical experience and expertise. Tele-ICU nursing practice leverages surveillance technology to facilitate and expedite patient care. Despite the growing number of critical care nurses practicing in this environment, little is known about tele-ICU nursing practice influence on ICU patient outcomes including avoiding FTR. This is the first research to report a comprehensive analysis of the influence of tele-ICU nursing interventions to prevent FTR.

Methods: The American Association of Critical Care Nurses (AACN) tele-ICU model of success (MOS) was used as the framework for this parallel convergent mixed methods study. An integrative review of the literature (n = 17) was first used to identify gaps related to tele-ICU nursing practice. Next, tele-ICU nurses’ characterizations of their interventions to prevent FTR were explored using qualitative interviews (n=19) using an integrated (inductive-deductive) approach to thematic analysis. Concurrently, secondary analysis of the electronic health records of ICU patients (n=861) diagnosed with a HAC was used to examine the extent to which DTNIs were predictors of prevention of FTR. Finally, triangulation was used to assess the extent of agreement, expansion and discordance in the study findings.

Findings: FTR patients had higher severity of illness, longer video assessment by tele-ICU nurses, and were more likely to have DTNIs related to hemodynamic instability. Four themes emerged from qualitative analysis: fundamental tele-ICU nurse attributes, proactive clinical practice, effective collaborative relationships, and strategic use of advanced technology. Mixed methods analysis revealed convergence between DTNIs and tele-ICU nurses’ characterizations of their practice.

Discussion: Several gaps identified in the literature review provided the basis for this mixed methods analyses of the phenomena of tele-ICU nurse interventions to prevent FTR. Mixed analyses found that DTNIs were consistent with tele-ICU nurses’ account of their interventions to prevent FTR. Tele-ICU nursing interventions to prevent FTR involve systems thinking and integration of complex factors. Prevention of FTR in the tele-ICU setting is influenced by tele-ICU nurses’ view of their role in preventing FTR, their ability to build effective collaborative relationships, and strategic use of technology to drive their proactive clinical practice.

Implications to practice: The information posited in this study provides a foundation for future research to develop evidenced-based quality indicators for tele-ICU nursing practice that positively influences patient care outcomes. Units supported by tele-ICU nurses should leverage their clinical experience and expertise to enhance care delivery. Objectives: Describe the tele-ICU model of care and what is known about the outcomes associated with its implementation. Discuss the pragmatic approach to the research design, implementation, and interpretation of findings.

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Presented At:

14th Annual BHSF Research Conference

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