Organizational and Teamwork

Factors of TeleIntensive Care Units

1. Michael S. Wilkes, MD, MPH, PhD,
2. James P. Marcin, MD, MPH,
3. Lois A. Ritter, EdD and
4. Sherilyn Pruitt, MPH
+ Author Affiliations
1. Michael S. Wilkes is a professor, Department of Internal Medicine and
director of Global Health, and James P. Marcin is a professor and
division chief, Pediatric Critical Care, Department of Pediatrics,
University of California, Davis School of Medicine, Sacramento,
California. Lois A. Ritter is a research manager, WRMA Inc, Sacramento,
California. Sherilyn Pruitt is director, Office of Programs and
Engagement in the Office of the National Coordinator for Health
Information Technology, US Department of Health and Human Services,
Washington, DC.
1. Corresponding author: James P. Marcin, md, mph, Professor and Division
Chief, Pediatric Critical Care, Department of Pediatrics, 2516 Stockton
Blvd, Sacramento, CA 95817 (e-mail: jpmarcin@ucdavis.edu).

Abstract
Background Use of teleintensive care involves organizational and teamwork
factors across geographic locations. This situation adds to the complexity of
collaboration in providing quality patient-centered care.
Objective To evaluate cross-agency teamwork of health care professionals caring
for patients in teleintensive care units in rural and urban regions.
Methods A national qualitative study was conducted in 3 US geographic regions
with teleintensive care programs. Discussions and interviews were held with key
participants during site visits at 3 hub sites (specialist services location) and 8
rural spoke sites (patient location). The effects of communication and culture
between the hub team and the spoke team on use of the services and effectiveness
of care were evaluated.

Results A total of 34 participants were interviewed. Specific organizational and

teamwork factors significantly affect the functionality of a teleintensive care
unit. Key operational and cultural barriers that limit the benefits of the units
include unrealistic expectations about operational capabilities, lack of trust, poorly
defined leadership, and a lack of communication policies. Potential solutions
include education on spoke facility resources, clearly defined expectations and
role reversal education, team-building activities, and feedback mechanisms to
share concerns, successes, and suggestions.
Conclusion Proper administration and attention to important cultural and
teamwork factors are essential to making teleintensive care units effective,
practical, and sustainable.

2016 American Association of Critical-Care Nurses