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21 April 2021

Telemedicine in critical care still not widely adopted despite technological advancements

Cochrane Review examines the international evidence base on the implementation of telemedicine in critical care

Stethoscope lying next to a smartphone

Researchers at King’s Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care and Guy’s and St Thomas’ NHS Foundation Trust have completed a two-year project that examined the evidence base on the implementation of remote diagnosis and treatment of patients using telecommunications (telemedicine) in critical care settings.

The team, which includes Dr Andreas Xyrichis, Dr Julia Philippou and Professor Jane Sandall, found that despite significant technological advancements, implementation of telemedicine in critical care is lagging partly due to challenges with accepting, adopting and using new technology in dynamic and complex healthcare environments.

The COVID-19 pandemic has meant that telemedicine and the role it plays in the treatment of patients in Intensive Care Units (ICUs) has received greater attention than ever before. It has enabled immediate bedside access to expert intensivists and connected patients with their families at a distance.

Examining the international evidence base, the King’s team found that while both staff and families valued telemedicine for its potential, hospital staff were also concerned that they lack appropriate training. They were also worried about lack of staffing and identified tensions between the bedside and telemedicine teams.

Based on these, and other findings, the project team issued recommendations for decision-makers to encourage adoption and successful implementation of telemedicine in critical care. The intention is that these recommendations can enable ICUs, especially in rural and remote areas, to better prepare for and respond to the unprecedented demand for critical care brought about by the current pandemic.

The COVID-19 pandemic has shown a bright light on the potential of telemedicine, especially in critical care, but research shows that its effectiveness is hindered by limited understanding of the factors affecting its successful implementation in practice. Currently, adoption of telemedicine in critical care appears haphazard and unplanned, which risks patient safety, quality of care and resource waste. Our Cochrane Review of qualitative evidence bridges this gap, and offers suggestions for health systems, programme managers and other stakeholders to consider when choosing to implement telemedicine in critical care.

Dr Andreas Xyrichis, lead author

About Cochrane Reviews

A Cochrane Review is a study of all the best available evidence generated through research in health care and health policy, which are published in the Cochrane Database of Systematic Reviews. The Reviews are therefore valuable sources of information for those receiving and providing care, as well as for decision-makers and researchers.

Read Healthcare stakeholders’ perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis on the Cochrane Library website.

In this story

Julia Philippou

Associate Dean (Postgraduate Taught Studies) and Reader in Nursing Education

Jane Sandall

Professor of Social Science and Women's Health