Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits.

Objective: This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation. Methods: We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n = 6), physicians (n = 3), nurses (n = 9), respiratory therapists (n = 5) and other (n = 1) from July 2011 to May 2013. Transcripts were analysed for thematic content. Findings: Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation. Conclusions: ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals. [ABSTRACT FROM AUTHOR]