Clinical Program Coordinator Tele-CICU RN Children's National Hospital Severn, Maryland, United States
Abstract:
Introduction: Nationally, pediatric cardiac intensive care units (CICU) are facing higher patient complexity and a widespread nursing shortage. Our CICU Command Center (CC) started operations in 2019 with the goals of improving multi-disciplinary communication to optimize patient care and preventing critical events. In 2021, two CICU nurses joined the staff in the CC. We present our preliminary experience of integrating our tele-CICU nursing practice to support bedside staff.
Methods: Between January 2021 and June 2022, tele-CICU nurse workflows were developed incorporating the American Association of Critical-Care Nurses’ Tele-Critical Care Nursing Practice Model. Patient surveillance is facilitated utilizing video monitoring, electronic records, telemetry, and an artificial intelligence tool (Etiometry) to provide an additional layer of clinical oversight and support. Our interventions stemming from virtual surveillance are categorized as follows: Communication Information Support (CIS), Clinical Decision Support (CDS), and Clinical Bedside Support (CBS). A Likert scale survey was distributed to the bedside staff to assess their perception of support and satisfaction. Results Between January 2021 and June 2022, a total of 790 tele-CICU nurse interventions were documented. Interventions were evenly distributed between CIS (n=309, 39%) and CDS (n=307,39%). CBS represented 22% (n=174). The survey yielded positive results with a 74% response rate. Approximately, 90% of respondents agreed/strongly agreed the tele-CICU nurse is a valuable additional resource for education and best practice. Additionally, 79% of the respondents perceived useful guidance and support.
Conclusion: In the current post-pandemic environment, the tele-CICU nurse model provides valuable clinical information, decision support, and targeted bedside support with a high level of CICU bedside nurse satisfaction. To our knowledge, this is the first report of this tele-CICU nursing care model in the pediatric cardiac ICU. Amid the nursing shortage, this novel clinical support system may offer a novel approach to nursing clinical support. Future studies, refinements in communication and workflows, and benchmarking should be developed to standardize, strengthen, and further measure the impact of this new care model.
