Table 1.

Barriers reported by tele-ICU nurses

Barriers	Examples	# of nurses
Barriers related to characteristics of the ICUs
Variety of ICUs	Different ICUs have different characteristics and differences in the way work is organized.	7
Variety in ICU care processes	Different ICUs have different patient care processes and protocols.	6
Variety of ICU staff	Different ICU clinicians have different personalities, behaviors and characteristics.	8
Limited ICU nurse experience	ICU RNs have limited experience in the ICU.	5
Barriers with regard to patient, patient information and patient care issues
Lack of and poor access to patient-related information	The tele-ICU RN has limited access to patient-related information or cannot find patient-related information.	3
Lack of care for patient from ICUs	ICU may be too busy with one patient and may not be able to provide care to the other patient.	2
Lack of knowledge of patient	The tele-ICU RN has limited knowledge or not the most up-to-date patient information about a patient.	7
Lack of or poor documentation	Documentation on patient care is lacking or poor.	6
Barriers in the relationship between tele-ICU and ICU
ICU’s lack of familiarity with tele-ICU staff and purpose	ICU staff has lack of familiarity with tele-ICU staff and the purpose of the tele-ICU.	10
Lack of acceptance of tele-ICU	The ICU clinicians do not accept the tele-ICU, do not want to work with the tele-ICU, and do not see value of the tele-ICU.	9
Lack of or poor communication with ICU	The communication between the tele-ICU RN and ICU staff is limited or poor.	6
Lack of familiarity with ICU staff	The tele-ICU RN is not familiar with the ICU staff.	9
Lack of or variety of trust between tele-ICU and ICU	There is a variety in trust from tele-ICU to ICUs and vice versa.	8
Tele-ICU RN has lack of awareness regarding of what’s happening in ICUs	Tele-ICU RN does not know what’s going on in the ICU. For example, how busy the ICU is, the workload of the ICU RNs, etc.	5
Variety in acceptance and use of tele-ICU	There are differences in level of acceptance and use of the tele-ICU by the ICUs. Some ICUs need the tele-ICU more than others.	9
Conflict with ICU	The tele-ICU RN has a different opinion about patient care than ICU staff.	6
Barriers with regard to the technology (equipment, devices, or health information technology)
Lack of familiarity with and knowledge of ICU equipment or devices	The tele-ICU RN does not know or is not familiar with ICU equipment and devices (e.g. ventilator, infusion pump, and monitors).	6
Problem with tele-ICU equipment or software	ICUs do not use tele-ICU software to document because ICUs have lack of familiarity with tele-ICU software such as VISICU software.	5
General IT problems	Tele-ICU RN has problem with IT, either with tele-ICU equipment/software or other IT problem(s).	2
Barriers with regard to the organization and characteristics of the tele-ICU
Variation in ICU assignment	The tele-ICU RN gets assigned to different ICUs for each shift.	2
Variation of tele-ICU staff, work styles and personalities	The clinicians in the tele-ICU have a variety of personalities and the tele-ICU RN has to learn to work with different personalities.	2
Barriers with regard to the job or task design of tele-ICU nurses
Cognitive or memory load	The tele-ICU RN has to remember different things, including ways of login into EHR, passwords, way to access information, etc.	9
High workload	The tele-ICU RN experiences high workload, for example because of the number of admissions, demands from multiple ICU staff, insufficient staff coverage, etc.	10
Interruption(s)	The tele-ICU RN is interrupted when performing his/her tasks	9
Staying vigilant	It is hard for tele-ICU RN to stay alert and awake, and maintain attention after prolonged periods in his/her shift.	3
Uncertainty	The tele-ICU RN experiences uncertainty with regard to what will happen next.	3