Table 3.

Categorization of the Forms of ICU Telemedicine Care Delivery

Care Delivery Practices	Examples in the Form of Respondent Quotes and Observations
Monitoring for physiological deterioration	“[The patient] started to deteriorate. [The telemedicine physician] gave us orders. He made changes. We had right there in that immediate, we had an improvement, and when the physicians came in the next morning, they were like, ‘Great! That’s great that there’s improvement.’” —Interview, ICU nurse
Prompting bedside providers for specific evidence-based practices	The ICU telemedicine nurse checked on the status of a patient who had a spontaneous breathing trial but not a sedation vacation. “I make circles on the chart, and then I call them at the end,” she explains how she fills in her charting. “I keep looking at the head of the beds. It’s an evidence-based practice … and it works.” She continues, “See, there’s a note for the SBT. I can put a check in—like checking off.” —Observations, telemedicine facility nurse
Serving as a resource for expert advice and guidance	“There’s someone there full-time so you don’t feel like you’re waking someone up at home, so whereas you may be a little hesitant to call if somebody was at home taking call, I have no hesitation for calling up the [telemedicine facility] just to kind of—to pick their brain.” —Interview, ICU physician
Collecting performance data for later auditing and feedback	“There’s a medication algorithm for alcoholics, and for regulatory reasons we had to do some auditing…. So there was about a good three months where the [telemedicine facility] audited every [alcohol withdrawal] patient we had on the protocol.” —Interview, ICU manager

Definition of abbreviation: SBT = spontaneous breathing trial.

These practices can be delivered in either effective or ineffective ways.