Developing Socio-Technical Components of a Tele-Critical Care Consultation Service for Hospitalized Patients at Risk for Intensive Care Unit Admission

Abstract

While a fraction of unplanned admissions to the intensive care unit are unavoidable and clinically warranted, a majority of unplanned admissions of lower-acuity patients can be avoided. In this study, we investigated the needs for developing and implementing a tele-critical care consultation (TC3) service at a large academic hospital in St. Louis, using an intervention mapping (IM) approach with input from a 10-member Stakeholder Advisory Board (SAB), including hospitalists, nurses, unit champions and leaders from the floor, and hospital rapid response team (RRT). We conducted four SAB meetings and identified three themes underlying the successful design and implementation of a tele-critical consult service: First, TC3 can streamline ICU admissions in one of two ways: by preventing avoidable, lower-acuity ICU admissions from floor, and by expediting unavoidable, higher-acuity admissions to the ICU from the floor. Second, TC3 can support three core functions remote monitoring, co-management, and clinical advisory. Third, TC3 workflow is comprised of TC3 service initiation, TC3 service care management, and TC3 service conclusion. We identified that the proposed TC3 service workflow can best be characterized as a socio-technical care system, as it heavily relies on technological components and human and social elements. We discuss the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe TC3 as a socio-technical system and interdependencies between its components and impact on outcomes.