In 2003, more than 30 years after AACN was founded and more than 50 years after the first intensive care units (ICUs) emerged, a team of nurses in Sacramento, California, started the first telehealth ICU or teleICU on the West Coast and the second in the United States. I was and am honored to be one of those nurses! What an exciting and daunting time that was. We had no idea what our role could or should be. Across the country, teleICU nurses, along with advanced practice registered nurses (APRNs), began nurse-driven projects aimed at improving compliance with ICU best practices (early identification and treatment of sepsis, glycemic control, low tidal volume ventilation, deep vein thrombosis prophylaxis, reductions in ventilator-associated pneumonia and more). The AACN TeleICU Nursing Consensus Statement provides additional information about teleICU nursing.
Fast forward to 2020, and every discipline is trying to figure out how to use technology to care for patients remotely. But fundamentally changing how patient care is delivered doesn’t happen overnight, even during a pandemic. In speaking with my colleagues at health systems across the country, RNs and APRNs working with and within teleICU centers are better equipped to rapidly adopt and implement the technology tools needed to promote social distancing, reduce exposure to COVID-19 and conserve personal protective equipment (PPE).
During the height of the pandemic at UMass Memorial Medical Center, critical care nurse practitioners (NPs) and physician assistants adapted quickly. They utilized the teleICU tools (in-room wall-mounted cameras and telehealth carts) used for remote patient care to complete visual assessments and guide the care of patients in isolation from within the ICU. Nurses and ancillary critical care team members also began to use these tools to reduce donning and doffing of PPE and decrease exposure to COVID-19.
Telemedicine carts are equipped with two-way audio-video functionality to support care providers’ remote connection to families with patients. These carts range in size and can also be equipped with peripheral devices such as remote camera control (pan, tilt and zoom) and high definition (10x-30x zoom capability). The zoom capability can allow the remote caregiver to zoom in to assess the patient (nail beds, skin, wounds, pupillary reaction) and devices in the room (IV pumps, ventilators). The definition is so clear that even the numbers on neonatal endotracheal tubes can be read by the remote care provider. Some carts have the capability to connect other peripheral devices such as otoscopes, derma scopes and stethoscopes.
We soon realized that we could use these same technologies to promote healing, prevent/treat anxiety, provide psychosocial support and, in some cases, say goodbye to those we could not save. In addition to the caregivers already mentioned, nurses and advanced practice providers connected patients and families to palliative care providers, social workers, behavioral health specialists and each other. It has become apparent that those who had some degree of experience with these telehealth tools adapted more quickly and had better adoption than those who did not. Regardless, we know that telehealth is here to stay. We need to learn from these experiences, both good and bad, to develop systems of care that appropriately use these tools to promote better, safer, more efficient patient-centered care.
Are telehealth tools being used in your units? How might critical care and acute care nurses and NPs with specialized knowledge use tools such as these to ensure that all patients benefit from expert care?
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