Summary of findings 1. Summary of qualitative findings.

Summary of review findings	Studies contributing to the review finding	GRADE‐CERQual assessment of confidence in the evidence	Explanation of GRADE‐CERQual assessment
CFIR Domain I: Factors affecting implementation related to intervention characteristics
Finding 1: Hospital staff’s personal experience, and anecdotes from colleagues, supported their belief that CCT has positive effects on patient care. Specifically, these effects were for patient safety and quality of care, support at the bedside by critical care experts, and standardisation of practice	Khunlertkit 2013; Moeckli 2013; Shahpori 2011a; Stafford 2008a; Ward 2015; Wilkes 2016	Moderate confidence	Downgraded to moderate confidence because of minor concerns about methodological limitations, coherence, and adequacy; and moderate concerns about relevance
Finding 2: Hospital staff and family members described several advantages of CCT. Bedside and hub staff strongly believed that the main advantage of CCT was having access to experts when bedside doctors were not available. Families also valued having access to critical care experts. In addition, hospital staff described how CCT could support clinical decision‐making and mentoring of junior staff	Jahrsdoerfer 2013; Kahn 2019; Khunlertkit 2013; Moeckli 2013; Shahpori 2011a; Stafford 2008a; Thomas 2017	High confidence	Graded as high confidence because of no or very minor concerns about methodological limitations, relevance, coherence, and adequacy
Finding 3: Bedside staff valued the potential adaptability of CCT to speak to local needs and practices. However, this was not always evident, with reported examples being mainly around developing camera usage etiquette and integration with local protocols	Moeckli 2013; Stafford 2008a; Thomas 2017	Low confidence	Downgraded to low confidence because of minor concerns about coherence; moderate concerns about relevance; and serious concerns about adequacy
Finding 4: Both bedside and hub clinicians expressed difficulties with the implementation of CCT. Key barriers related to implementation were perceptions of additional workload, need for more co‐ordination work, and concern around the presence of cameras	Moeckli 2013; Mullen‐Fortino 2012; Shahpori 2011a; Stafford 2008a; Ward 2015	Moderate confidence	Downgraded to moderate confidence because of minor concerns about coherence; moderate concerns about methodological limitations; and moderate concerns about adequacy
Finding 5: Cost considerations featured as an influencing factor in a limited way, with only a few examples noting the high cost of implementing CCT, especially compared to the cost of recruiting additional ICU staff	Shahpori 2011a; Stafford 2008a	Low confidence	Downgraded to low confIdence because of moderate concerns about methodological limitations; and serious concerns about relevance, and adequacy
CFIR Domain II: Factors affecting implementation related to outer setting
Finding 6: Hospital staff as well as family members perceived CCT to be providing a community benefit, specifically for patients' and families' desire to stay close to their local community without requiring transfer to specialist centres to access critical care expertise	Goedken 2017; Moeckli 2013; Shahpori 2011a; Ward 2015; Wilkes 2016	Moderate confidence	Downgraded to moderate confidence because of minor concerns about adequacy; moderate concerns about methodological limitations; and serious concerns about relevance
CFIR Domain III: Factors affecting implementation related to inner setting
Finding 7: Hospital staff greatly valued the nature and quality of social networks between the bedside and CCT hub teams. Key issues for them were trust, acceptance, teamness, familiarity and effective communication between the two teams	Hoonakker 2018; Jahrsdoerfer 2013; Kahn 2019; Khunlertkit 2013; Moeckli 2013; Mullen‐Fortino 2012; Stafford 2008a; Wilkes 2016	High confidence	Graded as high confidence because of no or very minor concerns about relevance, coherence, and adequacy; and minor concerns about methodological limitations
Finding 8: Hospital bedside staff were concerned over the hub team not being aware of local unit norms, values, and culture. This led local bedside teams to feel that CCT intruded on their practice	Kahn 2019; Moeckli 2013; Mullen‐Fortino 2012; Stafford 2008a; Ward 2015; Wilkes 2016	Moderate confidence	Downgraded to moderate confidence because of moderate concerns about methodological limitations, relevance, and adequacy
Finding 9: Bedside clinicians were reluctant to use CCT because they lacked clarity about its purpose, were concerned that their decision‐making skills would be weakened through remote supervision, and did not consider hub clinicians an equal counterpart in patient management. Hub clinicians were disengaged due to lack of role clarity and limited integration with patient care	Kahn 2019; Moeckli 2013; Shahpori 2011a; Stafford 2008a	Moderate confidence	Downgraded to moderate confidence because of minor concerns about methodological limitations, and adequacy; and moderate concerns about relevance.
Finding 10: Hospital locale shaped prioritisation of CCT, with staff in rural centres noting that CCT was of greater benefit to them considering their staff shortage and lack of critical care resources	Kahn 2019; Shahpori 2011a; Ward 2015; Wilkes 2016	Low confidence	Downgraded to low confidence because of moderate concerns about methodological limitations, relevance, and coherence; and serious concerns about adequacy
Finding 11: Bedside and hub clinicians perceived the absence of support from, and lack of engagement in dialogue with leaders and senior administrators during the implementation of CCT as major barriers. Listening to staff needs, and creating groundwork connections with them from the outset were perceived as facilitating factors to implementation	Kahn 2019; Wilkes 2016	Low confidence	Downgraded to low confidence because of minor concerns about methodological limitations; moderate concerns about relevance; and serious concerns about adequacy
Finding 12: Hospital staff expressed it was important to promote and offer training in the use of CCT before its implementation. This included rehearsing every step in the process, offering staff opportunities to ask questions and disseminating learning resources. Some also complained that experienced staff were taken away from bedside care and re‐allocated to the CCT hub team	Kahn 2019; Moeckli 2013; Shahpori 2011a; Stafford 2008a; Ward 2015	High confidence	Graded as high confidence because we had minor concerns about relevance, coherence, and adequacy; and moderate concerns about methodological limitations
Finding 13: Hospital staff reported the lack of access to information about how CCT staff, policies and procedures can be incorporated into the bedside workflow as a barrier to implementation	Moeckli 2013	Low confidence	Downgraded to low confidence because of minor concerns about methodological limitations; and serious concerns about relevance, and adequacy
CFIR Domain IV: Factors affecting implementation related to characteristics of individuals
Finding 14: Hospital staff's attitudes towards, knowledge about and value placed on CCT influenced acceptance of CCT. Staff were positive towards CCT because of its several advantages. But, some were concerned that the CCT hub staff were not able to understand the patient’s situation through the camera. Some were also concerned about confidentiality of patient data	Kahn 2019; Khunlertkit 2013; Moeckli 2013; Mullen‐Fortino 2012; Shahpori 2011a; Stafford 2008a; Thomas 2017	High confidence	Graded as high confidence because of minor concerns about methodological limitations, relevance, coherence, and adequacy
Finding 15: Hospital staff noted that acceptance and normalisation of CCT in their daily work took time; progressing through different stages of change did not occur at the same pace for everyone, with some remaining resistant to change	Kahn 2019; Khunlertkit 2013	Low confidence	Downgraded to low confidence because of minor concerns about coherence; moderate concerns about relevance; and serious concerns about adequacy
Finding 16: Hub nurses’ personal attributes, specifically about their motivation, multitasking competence and values, were noted as important enablers for implementation of CCT	Hoonakker 2013	Low confidence	Downgraded to low confidence because of minor concerns about methodological limitations; moderate concerns about adequacy; and serious concerns about relevance
CFIR Domain V: Factors affecting implementation related to process
Finding 17: Hospital staff were frustrated due to lacking a clear strategy for engagement; specifically lack of consistent training, the orientation of new and resistant staff to the hub facility, and timely co‐ordination for CCT implementation	Kahn 2019; Moeckli 2013	Low confidence	Downgraded to low confidence because of minor concerns about methodological limitations, and coherence; moderate concerns about relevance; and serious concerns about adequacy
Finding 18: Hospital staff were encouraged by the visibility of the intended benefits of CCT. They valued both quantitative feedback through auditing, as well as qualitative feedback through reflective accounts	Kahn 2019; Khunlertkit 2013; Thomas 2017	Moderate confidence	Downgraded to moderate confidence of minor concerns about coherence, and adequacy; and moderate concerns about relevance
Other factors affecting implementation
Finding 19: Hospital staff highlighted that CCT can support ICUs to overcome challenges associated with staff shortages especially during nights and weekends, and in rural hospitals where ICU nurses are assigned to different departments; and with retaining physicians and nurses. Some concerns over the potential negative impact of CCT on overall staffing levels were also expressed	Goedken 2017; Hoonakker 2013; Kahn 2019; Shahpori 2011a	Moderate confidence	Downgraded to moderate confidence because of minor concerns about relevance; moderate concerns about methodological limitations, and adequacy
Finding 20: Interactions between some bedside and CCT hub staff were featured with tension, frustration and conflict. Staff on both sides commonly described disrespect of expertise, resistance and animosity	Hoonakker 2013; Kahn 2019; Khunlertkit 2013; Moeckli 2013; Mullen‐Fortino 2012; Stafford 2008a; Wilkes 2016	High confidence	Graded as high confidence because of no or very minor concerns about coherence and adequacy; minor concerns about relevance; and moderate concerns about methodological limitations