(420) Staff Perspectives on a Telecritical Care Consult Service for Patients at Risk for ICU Admission

Introduction: Floor patients with borderline acuity are often transferred to intensive care units (ICUs) without hard indications. We recently implemented tele-critical care consultation (TC3) in our tertiary hospital to support the care of borderline floor patients and prevent some ICU transfers. TC3 is staffed by telemedicine intensivists and critical care nurses who remotely assess and monitor patients for 4-6 hours, in conjunction with rapid response nurses. Here, we characterize staff perceptions about TC3 use during pilot implementation.

Methods: Bedside, rapid response, and telemedicine staff caring for TC3 patients were invited to participate in semi-structured interviews and implementation surveys: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Interviews were analyzed using thematic analysis, and surveys using median [interquartile range] scores.

Results: Thirty staff (7 bedside providers, 5 bedside nurses, 6 rapid response nurses, 4 TC3 physicians, 5 TC3 nurses, 2 other) completed surveys. Nine completed interviews (4 bedside providers, 1 bedside nurse, 1 rapid response nurse, 2 TC3 physicians, 1 TC3 nurse).

Acceptability of TC3 had a median [IQR] of 16 [13-16] out of 20 possible, appropriateness was 16 [15-18], and feasibility was 16 [15-18]. Staff described TC3 as a valuable resource, particularly for night shifts, residents, and less-experienced nurses. They highlighted the timely and exceptional support provided for "gray zone" patients who lacked hard ICU indications. Furthermore, TC3 provided reassurance to patients, families, and staff. Some rapid response nurses perceived that TC3 added steps to their workflow, but all agreed that TC3 did not increase workload for bedside and telemedicine staff.

Some staff expressed concern about the limited number of TC3 mobile carts, limited clarity about the TC3 protocol, unclear distinction between the clinical scope of TC3 and rapid response, and communication lapses during shift changes.

Conclusions: Staff were highly satisfied with TC3. Additional education, resources, and support from clinician champions could address the implementation barriers and support the service's sustainability and scalability, with the long-term goal of optimizing patient outcomes.