Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits
Abstract
Objective This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation.Methods We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content.Findings Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation.Conclusions ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals.
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The most disruptive implementation of ICT in intensive care medicine in the recent past has been the introduction of tele-ICUs, which has been accompanied by several staff acceptance studies.
“The most disruptive implementation of ICT in intensive care medicine in the recent past has been the introduction of tele-ICUs, which has been accompanied by several staff acceptance studies [21,52,53].”
From Clinical requirements of future patient monitoring in the intensive care unit: qualitative study (2019) · cites this paper as [52]
Cites
McLeod, J. (1999) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209588.n8 · Cited by 3,964 · see citing works
Qualitative Research in Health Care
(2006) · Wiley eBooks · doi:10.1002/9780470750841 · Cited by 2,713 · see citing works
Crabtree, B. F., Miller, W. L., & Swenson, M. M. (1995) · Nursing Research · doi:10.1097/00006199-199507000-00011 · Cited by 956 · see citing works
Variation in critical care services across North America and Western Europe*
Wunsch, H., Angus, D. C., Harrison, D. A., Collange, O., Fowler, R., Hoste, E. A. J., de Keizer, N. F., Kersten, A., Linde‐Zwirble, W. T., Sandiumenge, A., et al. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318186aec8 · Cited by 626 · see citing works
Hospital Volume and the Outcomes of Mechanical Ventilation
Kahn, J. M., Goss, C. H., Heagerty, P. J., Kramer, A. A., O'Brien, C. R., & Rubenfeld, G. D. (2006) · New England Journal of Medicine · doi:10.1056/nejmsa053993 · Cited by 507 · see citing works
Haupt, M. T., Bekes, C., Brilli, R. J., Carl, L. C., Gray, A. W., Jastremski, M. S., Naylor, D. F., Rudis, M. I., Spevetz, A., Wedel, S. K., et al. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000094227.89800.93 · Cited by 330 · see citing works
A national view of rural health workforce issues in the USA
MacDowell, M., Glasser, M. L., Fitts, M., Nielsen, K., & Hunaker, M. (2010) · Rural and Remote Health · doi:10.22605/rrh1531 · Cited by 223 · see citing works
Pediatric critical care telemedicine in rural underserved emergency departments*
Heath, B. W., Salerno, R. A., Hopkins, A., Hertzig, J. S., & Caputo, M. P. (2009) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e3181a63eac · Cited by 149 · see citing works
Barriers to the up-take of telemedicine in Australia - a view from providers
Moffatt, J. J., & Eley, D. S. (2011) · Rural and Remote Health · doi:10.22605/rrh1581 · Cited by 146 · see citing works
Adoption of ICU Telemedicine in the United States
Kahn, J. M., Cicero, B. D., Wallace, D. J., & Iwashyna, T. J. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182a6419f · Cited by 122 · see citing works
Global Shortage of Health Workers, Brain Drain Stress Developing Countries
Kuehn, B. M. (2007) · JAMA · doi:10.1001/jama.298.16.1853 · Cited by 119 · see citing works
Impact of an Intensive Care Unit Telemedicine Program on a Rural Health Care System
Zawada, E. T., Herr, P., Larson, D., Fromm, R. E., Kapaska, D., & Erickson, D. (2009) · Postgraduate Medicine · doi:10.3810/pgm.2009.05.2016 · Cited by 112 · see citing works
Staff Acceptance of Tele-ICU Coverage
Young, L. B., Chan, P. S., & Cram, P. M. (2010) · CHEST Journal · doi:10.1378/chest.10-1795 · Cited by 103 · see citing works
Self-citationLilly, C. M., & Thomas, E. J. (2009) · Journal of Intensive Care Medicine · doi:10.1177/0885066609349216 · Cited by 102 · see citing works
Staff acceptance of a telemedicine intensive care unit program: A qualitative study
Moeckli, J., Cram, P., Cunningham, C., & Reisinger, H. S. (2013) · Journal of Critical Care · doi:10.1016/j.jcrc.2013.05.008 · Cited by 100 · see citing works
Self-citationMueller, K. J., Potter, A. J., MacKinney, A. C., & Ward, M. M. (2014) · Health Affairs · doi:10.1377/hlthaff.2013.1016 · Cited by 100 · see citing works
Awareness, experiences and perceptions of telehealth in a rural Queensland community
Bradford, N., Caffery, L. J., & Smith, A. C. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1094-7 · Cited by 82 · see citing works
Bedside Nurses' Perceptions of Intensive Care Unit Telemedicine
Mullen‐Fortino, M., Dimartino, J., Entrikin, L., Mulliner, S. J., Hanson, C. W., & Kahn, J. M. (2011) · American Journal of Critical Care · doi:10.4037/ajcc2012801 · Cited by 68 · see citing works
The impact of a tele-ICU on provider attitudes about teamwork and safety climate
Chu-Weininger, M. Y. L., Wueste, L., Lucke, J. F., Weavind, L. M., Mazabob, J. M., & Thomas, E. J. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2007.024992 · Cited by 58 · see citing works
Shahpori, R., Hebert, M., Kushniruk, A. W., & Zuege, D. J. (2010) · Journal of Critical Care · doi:10.1016/j.jcrc.2010.07.013 · Cited by 56 · see citing works
Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit
Romig, M. C., Latif, A., Gill, R. S., Pronovost, P. J., & Sapirstein, A. (2012) · Journal of Critical Care · doi:10.1016/j.jcrc.2011.12.007 · Cited by 44 · see citing works
Challenges faced in implementation of a telehealth enabled chronic wound care system
Barrett, M., Larson, A., Carville, K., & Skinner, I. (2009) · Rural and Remote Health · doi:10.22605/rrh1154 · Cited by 34 · see citing works
Wakefield, D. S., Ward, M. M., Miller, T. R., Ohsfeldt, R. L., Jaana, M., Lei, Y., Tracy, R., & Schneider, J. (2004) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2004.tb00054.x · Cited by 32 · see citing works
Zawada, E. T., Kapaska, D., Herr, P., Aaronson, M. L., Bennett, J., Hurley, B., Bishop, D., Dagher, H. N., Kovaleski, D., Melanson, T., et al. (2006) · PubMed · Cited by 30 · see citing works
Intensive Care Services in the Veterans Health Administration
Almenoff, P. L., Sales, A. E., Rounds, S., Miller, M., Schroeder, K., Lentz, K., & Perlin, J. A. (2007) · CHEST Journal · doi:10.1378/chest.06-3083 · Cited by 28 · see citing works
Remote care by telemedicine in the ICU
Boots, R. J., Singh, S., Terblanche, M., Widdicombe, N., & Lipman, J. (2011) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e32834a789a · Cited by 23 · see citing works
Intensive Care in Critical Access Hospitals
Freeman, V. A., Walsh, J., Rudolf, M., Slifkin, R. T., & Skinner, A. C. (2007) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2007.00078.x · Cited by 20 · see citing works
Mohr, N. M., Collier, J., Hassebroek, E. C., & Groth, H. (2013) · Journal of Critical Care · doi:10.1016/j.jcrc.2013.10.017 · Cited by 16 · see citing works
Staff satisfaction between 2 models of care for the chronically critically ill
Roulin, M., Boul'ch, M.-F., & Merlani, P. G. (2012) · Journal of Critical Care · doi:10.1016/j.jcrc.2011.12.019 · Cited by 12 · see citing works
An ethical challenge in critical care: The severely injured patient
Hassett, J. M., & Wear, S. (1987) · Journal of Critical Care · doi:10.1016/0883-9441(87)90007-4 · Cited by 6 · see citing works
Hawkins, C. L. (2012) · AACN Advanced Critical Care · doi:10.1097/nci.0b013e31825dff69 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Jacob, C., Sanchez-Vazquez, A., & Ivory, C. (2020) · JMIR mHealth and uHealth · doi:10.2196/15935 · Cited by 292 · see citing works
Clinical requirements of future patient monitoring in the intensive care unit: qualitative study
Poncette, A.-S., Spies, C., Mosch, L., Schieler, M., Weber-Carstens, S., Krampe, H., & Balzer, F. (2019) · JMIR Medical Informatics · doi:10.2196/13064 · Cited by 136 · see citing works
Tele-Critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee*
Subramanian, S., Pamplin, J. C., Hravnak, M., Hielsberg, C., Riker, R. R., Rincón, F., Laudański, K., Adzhigirey, L. A., Moughrabieh, M. A., Winterbottom, F. A., et al. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000004190 · Cited by 103 · see citing works
Kindle, R. D., Badawi, O., Celi, L. A., & Sturland, S. (2019) · Critical Care Clinics · doi:10.1016/j.ccc.2019.02.005 · Cited by 67 · see citing works
Big Data in the Veterans Health Administration: A Nursing Informatics Perspective
Deckro, J. P., Phillips, T., Davis, A., Hehr, A. T., & Ochylski, S. (2021) · Journal of Nursing Scholarship · doi:10.1111/jnu.12631 · Cited by 49 · see citing works
The role of tele-medicine in patients with respiratory diseases
Ambrosino, N., & Fracchia, C. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1383898 · Cited by 47 · see citing works
Xyrichis, A., Iliopoulou, K., Mackintosh, N. J., Bench, S. D., Terblanche, M., Philippou, J., & Sandall, J. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012876.pub2 · Cited by 41 · see citing works
Williams, D., Lawrence, J., Hong, Y., & Winn, A. N. (2020) · The Journal of Rural Health · doi:10.1111/jrh.12524 · Cited by 20 · see citing works
Park, J. Y., Zhong, X., Dong, Y., Barwise, A. K., & Pickering, B. W. (2022) · BMC Anesthesiology · doi:10.1186/s12871-021-01548-7 · Cited by 20 · see citing works
O’Shea, A. M. J., Fortis, S., Vaughan‐Sarrazin, M., Moeckli, J. K., Yarbrough, W. C., & Reisinger, H. S. (2018) · Journal of Critical Care · doi:10.1016/j.jcrc.2018.10.013 · Cited by 18 · see citing works
Self-citationWork System Barriers and Strategies Reported by Tele-Intensive Care Unit Nurses
Hoonakker, P., & Carayon, P. (2018) · Critical Care Nursing Clinics of North America · doi:10.1016/j.cnc.2018.02.008 · Cited by 17 · see citing works
Krupp, A. E., Martino, M. D., Chung, W., Chaiyachati, K. H., Agarwal, A. K., Huffenberger, A. M., & Laudański, K. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06287-6 · Cited by 15 · see citing works
Rayan, A., Al‐Ghabeesh, S. H., Fawaz, M. A., Behar, A., & Toumi, A. (2024) · Frontiers in Digital Health · doi:10.3389/fdgth.2024.1259409 · Cited by 13 · see citing works
Li, L., & Cotton, A. (2018) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2018.0006 · Cited by 13 · see citing works
Tele-ICU in the Unites States: Is a cost-effective model?
Robie, E. M., Cole, S., Suwal, A., & Coustasse, A. (2022) · International Journal of Healthcare Management · doi:10.1080/20479700.2022.2040877 · Cited by 6 · see citing works
Tele-ICU Patient Experience: Focus on Family-Centered Care
Huffenberger, A. M., Stamm, R., & Martin, N. D. (2019) · Springer eBooks · doi:10.1007/978-3-030-11569-2_10 · Cited by 5 · see citing works
Hadler, R. A., Gao, Y., Beck, B. F., Moeckli, J. K., Massarweh, N. N., Mosher, H. J., & Vaughan‐Sarrazin, M. (2024) · Journal of Palliative Medicine · doi:10.1089/jpm.2023.0548 · Cited by 3 · see citing works
Self-citationRemote Proactive Physiologic Monitoring in the ICU
Ramnath, V. R., & Malhotra, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-11569-2_2 · Cited by 3 · see citing works
Baroni, M. P., Bomfim, R. A., Gallon, B. C., Bim, C. R., Hespanhol, L., & Saragiotto, B. T. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-15372-7 · Cited by 1 · see citing works
Bhonagiri, D., Hillman, K., Lakshmanan, R., Shah, U., Harrison, R., Ali, I., Nalos, M., Sharma, A., Parr, M. J., Lombardo, L., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3152857/v1
Tele Intensive Care Nursing: A Systematic Review
Alptekin, H. M., YEREBAKAN, A. N., & Akyüz, N. (2025) · Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi · doi:10.38108/ouhcd.1334889
Jantzen, D., Marcellus, L., Damianos, D., & Irlbacher, G. (2025) · JBI Evidence Synthesis · doi:10.11124/jbies-24-00317
Rural-Urban Disparities in Inpatient Outcomes for Opioid Overdose: A Nationwide Analysis
Nadeem, M. A., Quazi, M. A., Khan, A., Adams, T. A., Awan, A. R., Sohail, A. H., Nasrullah, A., & Sheikh, A. B. (2025) · Substance Use & Addiction Journal · doi:10.1177/29767342251370455
Park, J., Zhong, X., Dong, Y., Barwise, A. K., & Pickering, B. W. (2022) · Figshare · doi:10.6084/m9.figshare.17870128
Krupp, A. E., Martino, M. D., Chung, W., Chaiyachati, K. H., Agarwal, A. K., Huffenberger, A. M., & Laudański, K. (2021) · Figshare · doi:10.6084/m9.figshare.14314592
Tiem, J. M. V., Faro, E. Z., Walhof, J. E. F., Good, M. K., Blum, J., & Reisinger, H. S. (2026) · SSM - Health Systems · doi:10.1016/j.ssmhs.2026.100227
Self-citation
- Authors
- Goedken, C. C., Moeckli, J., Cram, P. M., & Reisinger, H. S.
- Affiliations
- Iowa City VA Health Care System (US)
- Mount Sinai Hospital (CA)
- University of Iowa (US)
- Corresponding author
- Goedken, Cassie Cunningham
- Venue
- Intensive and Critical Care Nursing
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 40
- Pages
- 51-56
- ISSN
- 0964-3397 (ISSN-L)
- OpenAlex
- W2588172621
- Cited by
- 27
- References
- 31
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 6 · 2018: 3 · 2017: 1
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Intensive and Critical Care Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- tele-ICU, rural hospitals, organizational culture, employee perceptions, telemedicine, critical care staffing, staff recruitment and retention, patient transfer, standardization of care
- MeSH terms
- Adult, Attitude of Health Personnel, Female, Hospitals, Rural, Humans, Intensive Care Units, Longitudinal Studies, Male, Middle Aged, Nurses, Perception, Midwestern United States, Telemedicine, Qualitative Research
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