biostudies-literatureUnknown15(1)Abraham J<h4>Background</h4> Unplanned intensive care unit (ICU) admissions from medical/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs.<h4>Methods</h4> We conducted a qualitative study involving general observations of the units, shadowing of clinicians during patient transfers, and interviews with clinicians from the ED, medical/surgical floor units and their ICU counterparts, tele-ICU, and the rapid response team at a large academic medical center in St. Louis, Missouri, United States. We used a hybrid thematic analysis approach supported by open and structured coding using the Consolidated Framework for Implementation Research (CFIR).<h4>Results</h4> Over 165 hours of observations/shadowing and 26 clinician interviews were conducted. Our findings suggest that a tele-critical care consult (TC3) service can prevent avoidable, lower acuity ICU admissions by offering a second set of eyes via remote monitoring and providing guidance to bedside and rapid response teams in the care delivery of these patients on the floor/ED. CFIR-informed enablers impacting the successful implementation of the TC3 service included the optional and on-demand features of the TC3 service, around-the-clock availability, and continuous access to trained critical care clinicians for avoidable lower acuity (ALA) patients outside of the ICU, familiarity with tele-ICU staff, and a willingness to try alternative patient risk mitigation strategies for ALA patients (suggested by TC3), before transferring all unplanned admissions to ICUs. Conversely, the CFIR-informed barriers to implementation included a desire to uphold physician autonomy by floor/ED clinicians, potential role conflicts with rapid response teams, additional workload for floor/ED nurses, concerns about obstructing unavoidable, higher acuity admissions, and discomfort with audio-visual tools. To amplify these potential enablers and mitigate potential barriers to TC3 implementation, informed by this study, we propose <i>two key characteristics-</i>essential for extending the delivery of critical care services beyond the ICU<i>-</i>underlying a telemedicine critical care consultation model including its <i>virtual footprint</i> and <i>on-demand and optional</i> service features.<h4>Conclusion</h4> Tele-critical care represents an innovative strategy for delivering safe and high-quality critical care services to lower acuity borderline patients outside the ICU setting.Applied clinical informatics178-191https://www.ebi.ac.uk/biostudies/studies/S-EPMC10917611biostudies-literatureExpanding Critical Care Delivery beyond the Intensive Care Unit: Determining the Design and Implementation Needs for a Tele-Critical Care Consultation Service.PMC10917611Konzen LWhite JPalmer CAbraham JKandasamy MDrewry AFritz BfalseExpanding Critical Care Delivery beyond the Intensive Care Unit: Determining the Design and Implementation Needs for a Tele-Critical Care Consultation Service.<h4>Background</h4> Unplanned intensive care unit (ICU) admissions from medical/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs.<h4>Methods</h4> We conducted a qualitative study involving general observations of the units, shadowing of clinicians during patient transfers, and interviews with clinicians from the ED, medical/surgical floor units and their ICU counterparts, tele-ICU, and the rapid response team at a large academic medical center in St. Louis, Missouri, United States. We used a hybrid thematic analysis approach supported by open and structured coding using the Consolidated Framework for Implementation Research (CFIR).<h4>Results</h4> Over 165 hours of observations/shadowing and 26 clinician interviews were conducted. Our findings suggest that a tele-critical care consult (TC3) service can prevent avoidable, lower acuity ICU admissions by offering a second set of eyes via remote monitoring and providing guidance to bedside and rapid response teams in the care delivery of these patients on the floor/ED. CFIR-informed enablers impacting the successful implementation of the TC3 service included the optional and on-demand features of the TC3 service, around-the-clock availability, and continuous access to trained critical care clinicians for avoidable lower acuity (ALA) patients outside of the ICU, familiarity with tele-ICU staff, and a willingness to try alternative patient risk mitigation strategies for ALA patients (suggested by TC3), before transferring all unplanned admissions to ICUs. Conversely, the CFIR-informed barriers to implementation included a desire to uphold physician autonomy by floor/ED clinicians, potential role conflicts with rapid response teams, additional workload for floor/ED nurses, concerns about obstructing unavoidable, higher acuity admissions, and discomfort with audio-visual tools. To amplify these potential enablers and mitigate potential barriers to TC3 implementation, informed by this study, we propose <i>two key characteristics-</i>essential for extending the delivery of critical care services beyond the ICU<i>-</i>underlying a telemedicine critical care consultation model including its <i>virtual footprint</i> and <i>on-demand and optional</i> service features.<h4>Conclusion</h4> Tele-critical care represents an innovative strategy for delivering safe and high-quality critical care services to lower acuity borderline patients outside the ICU setting.2024-01-01T00:00:00Z2024 Jan2025-04-03T23:35:52.034Z2025-04-03T23:35:52.034ZS-EPMC109176113844796610.1055/s-0044-1780508