Sociotechnical Issues of Tele-ICU Technology

Abstract

Intensive care units (ICUs) are highly complex organizations where lives are hanging by a thread. Approximately 400,000 to 500,000 people die each year in American ICUs. The highly complex environment and large responsibilities put a burden on ICU staff including physicians and nurses. Research has shown that ICU physicians and nurses report high levels of workload and burnout that are related to lower quality of care provided to ICU patients and patient safety problems. Furthermore, there is a shortage of ICU personnel. In the past decades, the number of critical care beds has increased while the number of hospitals offering critical care services has decreased. Telemedicine may be one solution to deal with the shortage of ICU personnel. The tele-ICU technology represents the application of telemedicine in ICUs: ICU patients are monitored remotely by physicians and nurses trained in critical care. Recent estimates show that a nurse in the tele-ICU environment can monitor as many as 50 ICU patients in different ICUs, using the most recent telemedicine technology that provides access to patient information as well as video and audio links to patient rooms. The physicians and nurses in the tele-ICU collaborate with the physicians and nurses in the ICUs in what can be considered virtual teams. We know little about how the virtual team characteristics affect communication and trust between the participating members of the team. Furthermore, we know little about how the technological environment of the tele-ICU may affect the physicians and nurses’ workload and possibly burnout, and how this may affect quality of care and patient safety. In this chapter we describe the ICU and tele-ICU from a sociotechnical perspective, and examine how organizational factors may affect the jobs of nurses in the tele-ICU, and possible consequences for quality of work life, quality of care and patient safety.