Evidence-Based Practice Telemedicine In ICU

Evidence-Based Practice Telemedicine In ICU

The inevitability of change is something that has affected every context of human life, inclusive of various institutions such as hospitals. The 21^st century is characterized by great technological developments and innovation in the social, economic, and political aspects. Notably, the field of medicine has benefited intensively by the different changes that have been implemented in the various departments of health institutions. One such contemporary practice is the use of telemedicine in the ICU Settings. The telemedicine ICU, commonly referred to as tele-ICU, is the offsite administration of care to patients in the ICU in the absence of intensive care unit specialists or emergencies. (Vranas, et al., 2018). It’s important to note that, telemedicine in the ICU has been substantial in delivering services that cater to challenges prompted by the inadequacy of intensive care unit health practitioners. Another important factor to notice is that given the nature of the cost of the service to be quite expensive, telemedicine is currently being applied in limited proportion and only in hybrid settings. (Udeh, et al., 2018). Telemedicine, however, places some merits on the field of healthcare, especially in the ICU settings, while at the same time, it has an extent of drawbacks.

In nursing, the research conducted concerning the benefits of tele-ICU through evidence-practice urge medical practitioners and different health institutions to implement the application of such equipment in the ICU settings. Apart from enabling the health institutions to adapt to the rapidly changing technological world with inventions focused on the field of medicine, telemedicine in the ICU is crucial in allowing proper admission of quality healthcare patients in the ICU. Despite being that expensive, telemedicine in the ICU can be successfully implemented if the health facilities apply specific theories within the psychological and social context. These theories, together with the proper application of evidence-based practice and also the inclusion of the government, can be efficient and effective in the installation and use of tele-ICU. It’s important to note that such implementation requires prior scrutiny of the service’s pros and cons before it can be successfully implemented. The PICOT question of this paper is thus the comparison between tele-ICU and in-house hospitalist face-to-face care patient care techniques by listing the pros and cons and presenting the implementation strategies through EBP of tele-ICU.

Pros of tele-ICU

1. The first recognized benefit of tele-ICU is enhanced monitoring, early identification, and treatment of clinical illnesses. Notably, the equipment is capable of detecting any abnormalities in the change of the condition of the patient and thus aid effective replacement treatment strategies. It’s also capable of providing increased patient monitoring regardless of the time and can also be essential in the diagnosis of the patient. (Udeh, et al., 2018).
2. Telemedicine is a contemporary strategy used in treatment and care in the ICU, It is essential, primarily through the application of evidence-based practice and thus collectively improves the patient experience of quality care and the health of populations. (Melnyk, 2016).
3. Tele-ICU is also essential in the improved coordination of care, thereby limiting confusion and wrong diagnosis of patients. Through this technique, therefore, there’s increased access to referring physicians usually at early stages and also offers the possibility of an extended specialist.
4. It’s important to note that intensivists, otherwise referred to as ICU medical practitioners, are usually overworked, especially at night hours watching the patients, thereby presenting a chance of not correctly taking care of the patient. However, with tele-ICU, the patients are offered proper night vigil. (Udeh, et al., 2018).

Cons of Tele-ICU

1. It’s crucial to note that the medical attendants in the ICU are used to the routine practice of face to face observation and administration of patient care. With tele-ICU, their routines and traditional methods are usually interrupted. This implies that most medical practitioners are used to face-to-face consultation as it assures e patient and creates physical appeal as the doctor is sure with the condition of the patient. Adjusting to screen patients is, to some extent, taxing. (Tates et al., 2017).
2. The hospital settings with Tele-ICU are also limited to sufficient authority, and therefore the equipment is underutilized due to lack of proper management. This is evident, especially in the early stages of implementation. (Van Tiem, et al., 2020).
3. The problem also arises with new technology where the medical staff is finding it difficult to adjust to the acceptance of the use of tele-ICU. Consequently, there exists an extent of doubt as to the quality and precision of this equipment and may lead to a lack of quality service delivery by the nurses. (Udeh, et al., 2018).
4. Different research articles in evidence-based practice offer postulated benefits rather than the actual proven or experimented advantages of the equipment. This leaves the health facility wondering whether the equipment could affect the anticipated change or not. (Udeh, et al., 2018).
5. The other challenge in the use of tele-ICU is its high cost of acquisition and maintenance. Most government healthcare settings are not capable of acquiring the equipment given the high price and subsequently cater to its application’s needs.
6. There’s also the difficulty in hiring and or training the medical staff on how to use the tele-ICU and how it functions, and thus their response may negative, and also the cost of training may be high. (Kumar et al., 2013).
7. Audio and video technical issues are also capable of interrupting care, especially in emergencies. (Kleinpell et al., 2016).

Conceptual-Framework of the Implementation Process and the use of tele-ICU in Etowah County Alabama

The innovative aspect of tele-ICU is crucial to improving the quality of healthcare provided by health facilities. The essence of evidence-based practice is to provide relevant information concerning the history of the technique, clinician’s advice, and the evaluation of available resources, which will aid in the implantation of the use of tele-ICU.  By following the steps of EBP and successful implantation through the use of effective social and psychological theories, the goal of tele-ICU can be realized. (Melnyk, 2016). It’s crucial to note that the implementation exercise of Tele-ICU will incorporate the use of Rodger’s of innovation theory. The theory argues that there are specific processes that occur as people adapt to a new theory, and these steps provide a nuance between those who accept the idea quickly and those who do not. Notably, this theory is essential for technological implementations like those of the tele-ICU. During the implementation process, the categories of people are the innovators, early adopters, early majority, late majority, and new adopters, where there exists as a saturation point of the implementation exercise. (Kaminski, 2020).

In implementing the tele-ICU in Etowah County, Alabama, there will be a five-stage adoption process to which the health facility and the medical practitioners will undergo. The first stage is the knowledge and awareness stage in which the individual will be exposed to the new idea of tele-ICU but with sufficient information imparted. This will distinguish between the early adopters and the rest. The second stage is the persuasion and interest development stage, where the individuals will be given information and trained concerning the use of tele-ICU to spark their interests. The third stage places the individual in a persona context to decide the importance of the tele-ICU. They mentally anticipate how beneficial the new technology will be to the field of medicine. The fourth stage the implementation stage, where the equipment and all the necessary information about the installation and use of the tele-ICU will be put to full use in the hospital setting, assuming all medical staff is on board. The last and the final stage of this implementation exercise is the confirmation or the adoption stage in which the tele-ICU is used as full innovation in the county hospital. After a year, the innovation characteristics will be evaluated to ascertain the degree of success of implementing tele-IC in Etowah County, Alabama.

In the first stage of the implementation exercise, the innovator will pass information in order t create awareness on the new technique of patient monitoring through the use of mass media and interpersonal communication. Given the context of health institutions, interpersonal communication will serve best as per the limited number of medical practitioners and also maybe the application of the Hospital’s website. The time of the implementation process will be essential during the evaluation process.  This will be conducted at two stages the innovation adoption process as a whole and also the innovation adoption process at each stage. The evaluation exercise’s essence is to provide relevant information on the success of the newly introduced practice. (Kaminski, 2020).

Implementation Plan

Etowah County Alabama Government Hospital is the primary health delivery institution in Alabama. Being a county hospital, there are no necessary approval requests if not a formal unison consent by the Hospital’s board of management. The introduction of tele-ICU will be essential in adding value to the treatment process’s data-driven population management, quality healthcare, and, finally, the use of effective evidence-based practices. (Becker et al. 2016).  The critical environment needs to proper improvement given the increased mortality as a result of insufficient medical practitioners in the ICU and also the unavailability of appropriate monitoring techniques. In this regard, therefore, virtual-coverage will be essential in catering to the solutions to these problems. (Becker et al., 2016). In the context of technology adjustment, it’s crucial to note that the telehealth innovations are increasing in terms of their implementation in the United States, and Etowah County Hospital was lagging. Health providers countrywide have been increasingly looking for telehealth technological applications that are currently on the rise. Installing the tele-ICU in Etowah County Hospital Alabama, will place the Hospital at an advantage in future technological advancement preparations (Fathi et al., 2017). The position will not be just on a countrywide scale but on a global scale also.

It’s crucial to note the implementation exercise and proper evaluation of this technique will take one year. The first step would to introduce the new idea to the people and convince them of the potential benefits that it has to the Etowah Medical facility. There will be training of personnel, especially the ICU specialist. The resources this project will require are mainly the equipment of the virtual coverage, and also the personnel needed to train the relevant medical staff concerning the use of this equipment. There’s also a need to install an emergency high voltage back-up generator specifically meant for the ICU to cater for interference and any other anticipated breakdown in the hospital electric system. Theirs is also a need to acquire printing materials and visual media recording devices for the interviews and the admission of questionnaires as an essential part of the evaluation process regarding the success of the project. This training will be based on leadership roles in foreseeing the success of the implementation exercise and the active functioning of the tele ICU project. The ICU specialist should also possess a five-year Competency-Based training in ICU care and maintain sufficient skills in their interaction with the other physicians. (Amin et al., 2016). These individuals will first be trained on this new technique as the first recipients, and they will be required to channel the knowledge to the juniors, nurses, and physicians.

There’s a likelihood of the implementation exercise experiencing barriers such as a dislike of the equipment by patients and some medical staff as cultural barriers. There are also technological barriers, such as equipment breakdown. The first barrier can be overcome by educating both parties and enabling them to develop an interest in the tele-ICU. Employing qualified d technological personnel and sufficient training of ICU experts can solve the technical barrier. (Rogove et al., 2012).  The cost Of the exercise is as follows Tele-ICU equipment installation, licensing, and implementation goes at $3.5M; the Support Center will acquire a total of $1.0M, ICU facility renovation, and restructuring cost of $400K, project management and a consultant will be at $1.3M. The training exercise of each medical personnel will be $100K, and for 15 employees, it will cost $1.5. The evaluation materials will also go at $50K. The implementation of exercise costs totals $9.505M. (Coustasse et al., 2014). The proposed solution for revision extension or expansion is to firs assess the innovation characteristics of compatibility, trialability, complexity, relative advantage, and observability. These characteristics will provide viable information to ascertain the need for any changes.

References

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Becker, C., Frishman, W. H., & Scurlock, C. (2016). Telemedicine and tele-ICU: The evolution and differentiation of a new medical field. The American journal of medicine, 129(12), e333-e334.

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Kumar, S., Merchant, S., & Reynolds, R. (2013). Tele-ICU: efficacy and cost-effectiveness of remotely managing critical care. Perspectives in Health Information Management/AHIMA, American Health Information Management Association, 10(Spring).

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Udeh, C., Udeh, B., Rahman, N., Canfield, C., Campbell, J., & Hata, J. S. (2018). Telemedicine/Virtual ICU: Where Are We and Where Are We Going?. Methodist DeBakey cardiovascular journal, 14(2), 126–133. https://doi.org/10.14797/mdcj-14-2-126.

Van Tiem, J. M., Friberg, J. E., Wilson, J. R., Fitzwater, L., Blum, J. M., Panos, R. J., … Moeckli, J. (2020). Utilized or Underutilized: A Qualitative Analysis of Building Coherence During Early Implementation of a Tele-Intensive Care Unit. Telemedicine and e-Health. doi:10.1089/tmj.2019.0135.

Vranas, K. C., Slatore, C. G., & Kerlin, M. P. (2018). Telemedicine Coverage of Intensive Care Units: A Narrative Review. Annals of the American Thoracic Society, 15(11), 1256–1264. https://doi.org/10.1513/AnnalsATS.201804-225CME.