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Telemedicine implementation in COVID-19 ICU: balancing physical and virtual forms of visibility

Accepted version
Peer-reviewed

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Type

Article

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Authors

Pilosof, N 
Barrett, M 
Oborn, E 
Barkai, G 
Pessach, I 

Abstract

Objective: This case study examines the implementation of inpatient telemedicine in COVID-19 ICUs and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. Background: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit has a physical visual connection between the control room and the contaminated zone through a window, while the other has only a virtual connection with digital technologies. Methods: The findings are based on semi-structured interviews with Sheba medical staff, telemedicine companies, and the architectural design team, and observations at the COVID units during March-August 2020. Results: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users’ sense of control, orientation in space, teamwork, safety, quality of care, and wellbeing. Conclusions: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.

Description

Keywords

COVID-19, control room, healthcare design, inpatient telemedicine, model of care, visibility, COVID-19, Facility Design and Construction, Humans, Infection Control, Intensive Care Units, Israel, Organizational Case Studies, Patient Isolation, SARS-CoV-2, Telemedicine

Journal Title

Health Environments Research and Design Journal (HERD)

Conference Name

Journal ISSN

1937-5867
2167-5112

Volume Title

14

Publisher

SAGE Publications

Rights

All rights reserved
Sponsorship
This work was supported by the Centre for Digital Built Britain (CDBB) at the University of Cambridge [RG96631 NSAG/202]. E. Oborn is part supported by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands [Grant WMCLAHRC-2014-1].