The impact of a tele-ICU on provider attitudes about teamwork and safety climate.

OBJECTIVE To measure teamwork and safety climate in three intensive care units (ICUs) before and after remote monitoring by intensivists using telemedicine technology (tele-ICU). DESIGN Controlled pre tele-ICU and post tele-ICU cross-sectional survey. SETTING ICUs in two non-teaching community hospitals and one tertiary care teaching hospital. Subjects ICU physicians and nurses. INTERVENTIONS Remote monitoring of ICU patients by intensivists. OUTCOME MEASUREMENTS Teamwork Climate Scale (TWS), a Safety Climate Score (SCS) and survey items related to tele-ICU. MAIN RESULTS The mean (SD) teamwork climate score was 69.7 (25.3) and 78.8 (17.2), pre and post tele-ICU (p = 0.009). The mean SCS score was 66.4 (24.6) and 73.4 (18.5), pre and post tele-ICU (p = 0.045). While SCS scores within the ICUs improved, the overall SCS scores for these hospitals decreased from 69.0 to 65.4. Three of the non-scaled items were significantly different pre and post tele-ICU at p<0.001. The item means (SD) pre and post tele-ICU were: "others interrupt my work to tell me something about my patient that I already know" 2.5 (1.2) and 1.6 (1.3); "I am confident that my patients are adequately covered when I am off the unit" 3.2 (1.3) and 4.2 (1.1); and "I can reach a physician in an urgent situation in a timely manner" 3.8 (1.2) and 4.6 (0.6). CONCLUSIONS Implementation of a tele-ICU was associated with improved teamwork climate and safety climate in some ICUs, especially among nurses. Providers were also more confident about patient coverage and physician accessibility, and did not report unnecessary interruptions.