3. Evidence profile (findings 11‐20).

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
Assessment for each GRADE‐CERQual component
Methodological limitations	2 studies contributed to this finding. 1 study discussed  researcher reflexivity. The body of evidence contributing to this review finding was assessed as having no or very minor concerns about methodological limitations
Coherence	Minor concerns about coherence, because data were only reasonably consistent within studies
Relevance	Moderate concerns about relevance, because the studies were from only 2 settings from only 1 country, and perceptions concerning leadership are likely to differ across settings and countries
Adequacy	Serious concerns about adequacy, because the 2 contributing studies together offer only thin data
Overall GRADE‐CERQual assessment and explanation
Low confidence	Downgraded to low confidence because we had minor concerns about methodological limitations and coherence, moderate concerns about relevance, and serious concerns about adequacy
Contributing studies
Kahn 2019; Wilkes 2016
Finding 12: Hospital staff thought 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
Assessment for each GRADE‐CERQual component
Methodological limitations	5 studies contributed to this finding. 1 study discussed researcher reflexivity. 2 studies were assessed as having methodological limitations related to data analysis and data collection, of which 1 study was also assessed as having methodological limitations related to research design; and the other study was assessed as having methodological limitations related to recruitment. Another study was also assessed as having methodological limitations related to recruitment. The body of evidence contributing to this review finding was assessed as having moderate concerns about methodological limitations
Coherence	Minor concerns about coherence, because the data were only reasonably consistent within studies
Relevance	Minor concerns about relevance, because while the studies were all North American these were from different settings and countries; and perceptions about the need for training staff on new technology are unlikely to differ significantly across world regions
Adequacy	Minor concerns about adequacy, because the 5e studies together offered only reasonably rich data
Overall GRADE‐CERQual assessment and explanation
High confidence	Graded as high confidence because we had only minor concerns about relevance, coherence and adequacy, and moderate concerns about methodological limitations
Contributing studies
Kahn 2019; Moeckli 2013; Shahpori 2011a; Stafford 2008a; Ward 2015
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
Assessment for each GRADE‐CERQual component
Methodological limitations	1 study contributed data to this finding. It was assessed as having methodological limitations related to recruitment and researcher reflexivity. The body of evidence contributing to this review was assessed as having minor methodological limitations
Coherence	No or very minor concerns about coherence
Relevance	Serious concerns about relevance, because the study was from a single setting in 1 country; and local policies, procedures and workflows are likely to differ across settings and countries
Adequacy	Serious concerns about adequacy, because of only 1 study offering only thin data
Overall GRADE‐CERQual assessment and explanation
Low confidence	Downgraded to low confidence because we had no or very minor concerns about coherence, minor concerns about methodological limitations, and serious concerns about relevance, and adequacy
Contributing studies
Moeckli 2013
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 hub staff were not able to understand the patient’s situation through the camera. Some were also concerned about confidentiality of patient data
Assessment for each GRADE‐CERQual component
Methodological limitations	7 studies contributed data to this finding. 2 studies discussed researcher reflexivity. 2 studies were assessed as having methodological limitations related to research design, data collection, and data analysis. 1 study was assessed as having methodological limitations related to recruitment. The body of evidence contributing to this review finding was assessed as having minor concerns about methodological limitations
Coherence	Minor concerns about coherence, because the data were only reasonably consistent within studies
Relevance	Minor concerns about relevance, because while the studies were all North American these were from multiple settings and different countries; and the focus of the finding is on technological features of CCT that are unlikely to differ across world regions
Adequacy	Minor concerns about adequacy, because the 7 contributing studies together offer only moderately rich data
Overall GRADE‐CERQual assessment and explanation
High confidence	Graded as high confidence because we only had minor concerns about methodological limitations, relevance, coherence, and adequacy
Contributing studies
Kahn 2019; Khunlertkit 2013; Moeckli 2013; Mullen‐Fortino 2012; Shahpori 2011a; Stafford 2008a; Thomas 2017
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 with the same pace for everyone, with some remaining resistant to change
Assessment for each GRADE‐CERQual component
Methodological limitations	2 studies contributed data to this finding. 1 study assessed researcher reflexivity.  The body of evidence contributing to this review finding was assessed as having no or very minor concerns about methodological limitations
Coherence	Minor concerns about coherence, because the data were only reasonably consistent within studies
Relevance	Moderate concerns, because the studies were from a limited range of setting from only 1 country; and the finding's focus on pace of acceptance of new technology is likely to differ across settings and countries
Adequacy	Serious concerns about adequacy, because the 2 contributing studies only offer thin data
Overall GRADE‐CERQual assessment and explanation
Low confidence	Downgraded to low confidence because we had no or very minor concerns about methodological limitations, minor concerns about coherence, moderate concerns about relevance, and serious concerns about adequacy
Contributing studies
Kahn 2019; Khunlertkit 2013
Finding 16: Hub nurses’ personal attributes, specifically with regard to their motivation, multitasking competence and values were noted as important enablers for implementation of CCT
Assessment for each GRADE‐CERQual component
Methodological limitations	1 study contributed data to this finding. It was assessed as having methodological limitations related to research design, recruitment strategy, and researcher reflexivity. The body of evidence contributing to this review finding was assessed as having minor concerns about methodological limitations
Coherence	No or very minor concerns about coherence
Relevance	Serious concerns about relevance, because the data came from a single setting in 1 country; and the issue of nurses' personal attributes and motivation is highly likely to vary significantly across settings and countries
Adequacy	Moderate concerns about adequacy, because the 1 study offered only moderately rich data
Overall GRADE‐CERQual assessment and explanation
Low confidence	Downgraded to low confidence because we had no or very minor concerns about coherence, minor concerns about methodological limitations, moderate concerns about adequacy, and serious concerns about relevance
Contributing studies
Hoonakker 2013
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
Assessment for each GRADE‐CERQual component
Methodological limitations	2 studies contributed data to this finding. 1 study assessed researcher reflexivity. 1 study was assessed as having methodological limitations related to recruitment. The body of evidence contributing to this review finding was assessed as having minor concerns about methodological limitations
Coherence	Minor concerns about coherence, because the data were only reasonably consistent within  studies
Relevance	Moderate concerns about relevance, because the studies were from a limited range of settings in a single country, and the issue of staff engagement is likely to differ across settings and countries
Adequacy	Serious concerns about adequacy, because the 2 studies together offer only thin data
Overall GRADE‐CERQual assessment and explanation
Low confidence	Downgraded to low confidence because we had minor concerns about methodological limitations and coherence, moderate concerns about relevance, and  serious concerns about adequacy
Contributing studies
Kahn 2019; Moeckli 2013
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
Assessment for each GRADE‐CERQual component
Methodological limitations	3 studies contributed data to this finding. 2 studies discussed researcher reflexivity. The body of evidence contributing to this review finding was assessed as having no or very minor concerns about methodological limitations
Coherence	Minor concerns about coherence, because the data were only reasonably consistent within studies
Relevance	Moderate concerns about relevance, because the data came from a limited range of setting in a single country, and the value staff place on different kinds of feedback, and on reflection in particular, is likely to differ across countries and world regions
Adequacy	Minor concerns about adequacy, because the 3 studies together offer only reasonably rich data
Overall GRADE‐CERQual assessment and explanation
Moderate confidence	Downgraded to moderate confidence because we had no or very minor concerns about methodological limitations, minor concerns about coherence, and adequacy; and moderate concerns about relevance
Contributing studies
Kahn 2019; Khunlertkit 2013; Thomas 2017
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
Assessment for each GRADE‐CERQual component
Methodological limitations	5 studies contributed data to this finding. 1 study discussed researcher reflexivity. 2 studies were assessed as having methodological limitations related to data analysis and collection, of which 1 was also assessed as having methodological limitations related to recruitment; and the other was assessed as having methodological limitations related to research design. Another study was also assessed as having methodological limitations related to research design and recruitment. The body of evidence contributing to this review finding was assessed as having moderate concerns about methodological limitations
Coherence	No or very minor concerns about coherence
Relevance	Minor concerns about relevance, because while issues concerning retention of physicians and nurses are unlikely to differ significantly across world regions, the studies supporting this finding were only from North America
Adequacy	Moderate concerns about adequacy, because the 5 contributing studies together offered only moderately thin data
Overall GRADE‐CERQual assessment and explanation
Moderate confidence	Downgraded to moderate confidence because we had no or very minor concerns about coherence, minor concerns about relevance, and moderate concerns about methodological limitations and adequacy
Contributing studies
Goedken 2017; Hoonakker 2013; Kahn 2019; Shahpori 2011a
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
Assessment for each GRADE‐CERQual component
Methodological limitations	7 studies contributed to this finding. 1 study discussed researcher reflexivity. 2 studies were assessed as having methodological limitations related to research design, of which 1 was also assessed as having methodological limitations related to data analysis and collection; and the other was assessed as having methodological limitations related to recruitment. Another study was also assessed as having methodological limitations related to recruitment. The body of evidence contributing to this review finding was assessed as having moderate concerns about methodological limitations
Coherence	No or very minor concerns about coherence
Relevance	Minor concerns about relevance, because while issues concerning friction across different teams of health professionals have been noted in research worldwide, the studies supporting the current finding were only from North America
Adequacy	No or very minor concerns about adequacy
Overall GRADE‐CERQual assessment and explanation
High confidence	Graded as high confidence because we had no or very minor concerns about coherence and adequacy, only minor concerns about relevance, and moderate concerns about methodological limitations.
Contributing studies
Hoonakker 2013; Kahn 2019; Khunlertkit 2013; Moeckli 2013; Mullen‐Fortino 2012; Stafford 2008a; Wilkes 2016