Tele-intensive Care Research Articles

Outcomes of a tele-intensive care unit pharmacist on the management of diabetic ketoacidosis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The tele-intensive care unit (tele-ICU) pharmacist facilitates patient-specific diabetic ketoacidosis (DKA) treatment utilizing guideline-directed therapy. This study was designed to determine how patient-specific interventions by a tele-ICU pharmacist affected patients with DKA compared to the standard of care. This retrospective cohort study utilized custom reports and manual chart review to evaluate the electronic health records of patients 18 years or older who received continuous intravenous insulin and were admitted for DKA between January 2019 and December 2020. The primary endpoint was time to DKA resolution, defined by the patient meeting at least 2 of the following criteria: a serum bicarbonate concentration of at least 18 mEq/L, an arterial pH of greater than 7.3, and closure of the anion gap (less than or equal to 12 mEq/L). Patients treated with tele-ICU pharmacist patient-specific interventions reached DKA resolution 7.32 hours earlier than patients treated with the standard of care (22.16 vs 29.48 hours; P = 0.0019). There was no statistically significant difference between the groups for ICU length of stay, time until subcutaneous insulin administration, incidence of hypoglycemia, incidence of severe hypoglycemia, and sodium bicarbonate use. In patients who received a tele-ICU pharmacist intervention, there was a statistically significant increase in the volume for fluid resuscitation and the amount of total continuous insulin infused after ICU admission and a statistically significant reduction in the time between laboratory draws. Treatment of patients with tele-ICU pharmacist patient-specific interventions was associated with faster DKA resolution, more frequent laboratory monitoring, and a higher volume of insulin and fluids infused than in patients treated with protocol-driven therapy.

Managed critical care: impact of remote decision-making on patient outcomes.

Tele-intensive care unit (tele-ICU) use has become increasingly common as an extension of bedside care for critically ill patients. The objective of this work was to illustrate the degree of tele-ICU involvement in critical care processes and evaluate the impact of tele-ICU decision-making authority. Previous studies examining tele-ICU impact on patient outcomes do not sufficiently account for the extent of decision-making authority between remote and bedside providers. In this study, we examine patient outcomes with respect to different levels of remote intervention. Analysis and summary statistics were generated to characterize demographics and patient outcomes across different levels of tele-ICU intervention for 82,049 critically ill patients. Multivariate logistic regression was used to evaluate odds of mortality, readmission, and likelihood of patients being assigned to a particular remote intervention category. Managing (vs consulting) physician type influenced the level of remote intervention (adjusted odds ratio [AOR], 2.42). A higher level of tele-ICU intervention was a significant factor for patient mortality (AOR, 1.25). Female sex (AOR, 1.05), illness severity (AOR, 1.01), and higher tele-ICU intervention level (AOR, 1.13) increased odds of ICU readmission, whereas length of stay in number of days (AOR, 0.93) and consulting (vs managing) physician type (AOR, 0.79) decreased readmission odds. This study's findings suggest that higher levels of tele-ICU intervention do not negatively affect patient outcomes. Our results are a step toward understanding tele-ICU impact on patient outcomes by accounting for extent of decision-making authority, and they suggest that the level of remote intervention may reflect patient severity. Further research using more granular data is needed to better understand assignment of intervention category and how variable levels of authority affect clinical decision-making in tele-ICU settings.

Tele-Intensive Care Unit Program in Brazil: Implementation and Expansion.

In this scientific report, we aimed to describe the implementation and expansion of a Tele-Intensive Care Unit (Tele-ICU) program in Brazil, highlighting the pillars of success, improvements, and perspectives. Tele-ICU program emerged during the COVID-19 pandemic at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), focusing on clinical case discussions and training of health practitioners in public hospitals of the state of São Paulo in Brazil, to support health care professionals for treating COVID-19 patients. The success of implementing this initiative endorsed the project expansion to other five hospitals from different macroregions of the country, leading to the Tele-ICU-Brazil. These projects assisted 40 hospitals, allowing more than 11,500 teleinterconsultations (exchange of medical information between health care professionals using a licensed online platform) and training more than 14,800 health care professionals, reducing mortality and length of hospitalized patients. A segment in telehealth for the obstetrics health care was implemented after detecting these were a susceptible group of patients to COVID-19 severity. As a perspective, this segment will be expanded to 27 hospitals in the country. The Tele-ICU projects reported here were the largest digital health ICU programs ever established in Brazilian National Health System until know. Their results were unprecedented and proved to be crucial for supporting health care professionals nationwide during the COVID-19 pandemic and guide future initiatives in digital health in Brazil's National Health System.

Implementation of Tele-Intensive Care Unit Services During the COVID-19 Pandemic: A Systematic Literature Review and Updated Experience from Shandong Province.

Background: While the use of telemedicine had been expanding before the initial outbreak of COVID-19, the pandemic has dramatically accelerated its implementation and expanded its usage in many hospitals. Tele-intensive care unit (ICU) is a specialized type of telemedicine that adapts available technologies to the unique needs of critically ill patients. We published an editorial in 2020 describing our initial experiences of Tele-ICU application in Shandong Province. Here, we update our insights gained over the past 2 years, and we provide a systematic review of the literature to compare our perspectives with those from other institutions. Methods: We performed a systematic literature review of publications describing the use of telemedicine in an ICU setting during COVID-19. The PubMed database was searched for studies published after January 1, 2020, which offered detailed descriptions of tele-ICU usage. Extracted data included details regarding tele-ICU technologies, descriptions of the institution, usage cases, assessments of tele-ICU effectiveness, and site-reported opinions (e.g., advantages, disadvantages). Results: We screened 162 studies resulting from the PubMed literature search, along with one expert recommendation. Of the 112 full-text articles retrieved, 11 were selected for inclusion in this qualitative summary. All were retrospective descriptions of tele-ICU experiences at a single site. Some pairs of included articles reported results from the same institution, with seven unique sites being described. Three sites employed centralized models of tele-ICU, while four allowed staff to participate from distant locations. Five sites collected user-reported feedback regarding tele-ICU. While the advantages and disadvantages described rarely overlapped directly between sites, many reported positive opinions of tele-ICU use overall. Conclusions: The potential applications of tele-ICU technologies vary widely, making them highly adaptable to the needs of individual institutions. Tele-ICU has proven invaluable to some hospitals during COVID-19 due to its effectiveness at aiding patient care while mitigating risk to health care workers.

Opinions of Physicians Working in Intensive Care on Telemedicine and Tele-intensive Care

Opinions of Physicians Working in Intensive Care on Telemedicine and Tele-intensive Care

The Impact of Digital Health Transformation Driven by COVID-19 on Nursing Practice: Systematic Literature Review.

BackgroundThe COVID-19 pandemic has accelerated the uptake of digital health innovations due to the availability of various technologies and the urgent health care need for treatment and prevention. Although numerous studies have investigated digital health adoption and the associated challenges and strategies during the pandemic, there is a lack of evidence on the impact on the nursing workforce.ObjectiveThis study aims to identify the impact of digital health transformation driven by COVID-19 on nurses.MethodsThe online software Covidence was used to follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Relevant scientific health and computing databases were searched for papers published from January 2020 to November 2021. Using the 8D sociotechnical approach for digital health in health care systems, the papers were analyzed to identify gaps in applying digital health in nursing practice.ResultsIn total, 21 papers were selected for content analysis. The analysis identified a paucity of research that quantifies the impact of the digital health transformation on nurses during the pandemic. Most of the initiatives were teleconsultation, followed by tele–intensive care unit (tele-ICU), and only 1 (5%) study explored electronic medical record (EMR) systems. Among the sociotechnical elements, the human-related factor was the most explored and the system measurement was the least studied item.ConclusionsThe review identified a significant gap in research on how implementing digital health solutions has impacted nurses during the COVID-19 pandemic. This gap needs to be addressed by further research to provide strategies for empowering the nursing workforce to be actively involved in digital health design, development, implementation, use, and evaluation.

Integration Strategy for e-Intensive Care Unit: A Narrative Review and Implementation Plan.

Introduction: The objectives of this article are to review previously established tele-intensive care unit (ICU) services describing their impact at the technical and medical level, and to propose an implementation plan to equip health care facilities in need of telehealth. Materials and Methods: We searched MEDLINE, EMBASE, PubMed, and ISI web of knowledge, using terms related to "e-ICU" and "tele-ICU" from inception to May 2021. Discussion: At the technical level, an increase in private insurance enrollment and routine checkups, as well as a reduction in hospital utilization rates and improvement in health outcomes was seen in the aftermath of the adoption of telehealth insurance mandates. Moreover, e-ICU helped reducing mortality and length of hospital stay of critically ill patients. The main approach to implementation should include features that are widely accepted for quality improvement, including being focused on patient-centered outcomes, having strong executive support, and targeting changes that were known to improve outcomes. HL7 Fast Healthcare Interoperability Resources stands out as one of the best candidates to achieve structural interoperability for patient health records. Conclusions: Adoption of tele-ICU services requires a substantial up-front investment and ongoing cost of maintenance. This could be challenging for hospitals with low budgets. Hence the importance of further investigating more efficient strategies of e-ICU services integration and implementation.

Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review.

Telemedicine intensive care unit (Tele-ICU) programs entail command centers staffed with intensivists and critical care nurses who electronically aid with and deliver real-time information to frontline clinicians. The benefits of Tele-ICU are numerous, but the barriers to it often prove insurmountable, accounting for slow adoption in rural and underserved areas where it is needed the most. Remote monitoring can quickly detect patient deterioration, while consultation provided by a remote intensivist expands the capabilities of smaller facilities. The emergence of the coronavirus disease 2019 (COVID-19) pandemic has brought about a sense of urgency, paving the way for the successful adaptation of tele-intensive care concepts. The goal of this scoping review is to map out the available published data regarding healthcare professionals’ experiences with implementing Tele-ICU modalities during the COVID-19 pandemic. A primary literature search was performed on PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from October 2020 to October 2021. Of the 1,083 records screened, 19 were identified as meeting our inclusion criteria and selected for the final scoping review. Five major areas of Tele-ICU use were identified: teleconsultation, telerounding, telemonitoring, family visitation via teleconference, and changing of hospital infrastructure. A heterogeneous mix of improvised Tele-ICU platforms emerged with a common theme of interdisciplinary and family collaboration in the care of critically ill patients. Existing Tele-ICU systems were expanded, and novel programs were launched. A groundbreaking national network in the U.S. (NETCCN) will standardize the deployment of Tele-ICU and expand its reach. Future research should focus on determining accurate costs and the most reliable forms of remote communication, physician compact agreement licensure, the practical composition of Tele-ICU teams, and standardized access to the electronic health record.

Digital Based Intensive Care Networks

The Corona pandemic is a clear demonstration of the need for an alternative to face-to-face medicine. This demand makes telemedicine the tool of choice. In the preliminary stage of the Virtual Hospital North Rhine-Westphalia (VKh), tele-intensive care consultation services have contributed to both a benefit in terms of care and a benefit for individual patients. The task now is to roll out and use digitally-supported intensive-care networks across the board, including throughout Europe. The goal of telemedicine is to ensure comprehensive patient care - also across sector boundaries of the healthcare system - and to improve quality. Tele-intensive care is already an evidence-based added value and addresses current and future challenges such as resource shortage and citizen-centered care. The Virtual Hospital NRW is a telemedical network structure that is unique in Germany. It provides telemedical services from expert centers in a quality-assured and comprehensive manner for general hospitals as well as for outpatient players. Telemedical services help to overcome rigid sector boundaries and to optimize treatment processes. As a result, service-differentiated care networks are goal-oriented. The medium-term perspective could be cross-border network structures. Medical expertise and also intensive care data, both from care and research, could thus be used throughout Europe. In October 2021, the Aachen Expert Center reported on its first 112 telemedically co-managed COVID-19 patients as part of the preliminary stage of the virtual hospital. With a lethality rate of 34.2% in the group of ventilated severely ill COVID-19 patients and a transfer rate of 8%, high-quality care close to the patient's home was achieved through tele-intensive medical consultation services.

Tele-critical health care: Lessons learned from the pandemic

The approach of remotely managing critically ill patients via an off-site command center was implemented since decades. However, SARS COV-2 pandemic lockdown triggered an urgent need for more innovations to ensure the continuity of intensive care units services when self-isolation was needed to prevent and reduce infection rates. Hence, implementing tele-intensive care units (tele-ICU) became a must and seems to be the future system cornerstone. The Society of Critical Care Medicine's Tele-ICU committee has recently described various models of tele-critical care (TCC) and its current adapted applications [1]. The ability to regionalize advanced critical care support such as nonconventional mechanical ventilation modes, extracorporeal membrane oxygenation, and other complex needs may be simplified with telemedicine [2]. Experienced intensivists can provide a real-time support to the local teams and participate to the decision making while performing virtual rounds using high-definition audio/visual (A/V) equipment. Moreover, TCC may enhance the intervention quality for emergency situations such as advanced cardiac life support. The immediate delivery of an intensivist to the room via A/V technology may save time and promptly initiate life-saving procedures. Instead of “all hands-on deck” approach, code leadership by a tele-ICU intensivist may allow to reduce the number of the on-site responding staff. The benefit was objective in several scenarios during the pandemic era and enabled a full compliance with the social distancing requirements [3]. The COVID Caregiver Cockpit is an approved connected health care solution which is compliant with the FDA classification for Mobile Medical Devices. It offers various enhanced features that allow remote patient monitoring, and secure inpatient ward staff communications. COVID Caregiver Cockpit might be an example of the great flexibility and adaptability of TCC solutions with unexpected emergencies [4]. The cost of Tele-ICU varies depending on the setting, hardware, software, training, and compatibility issues with other health systems. Cost was usually considered as limiting factor for the implementation of eHealth solutions. However, the return on investment (ROI) for an implemented Tele-ICU seems to be satisfactory especially in case of shortage in bedside board-certified intensivists [5]. Physician acceptance of TCC technologies was not optimal at the beginning of the experience. However, the urgent need during the pandemic has permitted to prove the TCC efficacy and increased its acceptability. Based on this objective benefit of TCC, several savant and scientific societies recommended the integration of telemedicine consultations into routine clinical care [6]. Recent reviews of the literature provided several examples of successfully implemented telehealth services. A framework of patient-centered telehealth models implementation should be introduced in all clinical practice settings [7,8].

Telemedicine in Intensive Care Units: Scoping Review.

BackgroundThe role of telemedicine in intensive care has been increasing steadily. Tele–intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU.ObjectiveThis scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research.MethodsA research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings.ResultsA total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU.ConclusionsThe benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention.International Registered Report Identifier (IRRID)RR2-10.2196/19695

Tele-U to Tele-ICU: Telehealth Nursing Education.

The use of telehealth technology in various health care settings continues to expand. Such technology allows intensive care units to monitor patients living in remote locations and to intervene early when a patient's condition declines or a critical event occurs. The use of telehealth can also support nurses and help meet staffing challenges, which have increased in intensive care units during the COVID-19 pandemic. Currently, however, there are no formal requirements for telehealth education in nursing education or for telehealth orientation in nursing practice. To develop a telehealth curriculum based on telehealth competencies that would be broad enough to encompass all educational levels of nursing students and to support the current nursing workforce. A telehealth curriculum was designed that included an overview of telehealth, camera considerations, equipment, troubleshooting, reimbursement, legislation, and quality measures. These topics were then organized and developed into 6 online interactive video modules and simulation experiences. The curriculum topics pertinent to the tele-intensive care unit are discussed in this article. Completion of the telehealth curriculum or a formal telehealth orientation session may provide nurses with an understanding of the principles of telehealth and the skills needed to provide high-quality patient care using telehealth best practices. As the use of telehealth continues to expand, nursing education and practice should work together to address the needs of the nursing workforce and staffing challenges, specifically in the intensive care unit setting.

Tele-Intensive Care and the Current Situation in Turkey, Opportunities, Restrictions

Intensive care treatment needs and costs are expected to increase with the ageing population in our country and the world. Tele-intensive care unit (Tele-ICU) applications can provide an alternative solution to treat and follow up critical patients remotely. It can help use existing resources efficiently. With the Tele-ICU program, intensive care specialists will reach all intensive care beds in the country without restrictions. They will evaluate the patients’ situations with all data from electronic recording systems. However, problems with some legal regulations or terms of job descriptions, deterioration of patient-doctor, doctor-patient’s relative relationships, or some infrastructure deficiencies when using the Tele-ICU system could override the potential benefit of the new solution strategy. This review was written to inform about Tele-ICU, draw attention to opportunities, shortcomings, and limitations if Tele-ICU is applied in our country, and ensure that the necessary steps are taken to resolve these deficiencies.Alternate abstract: Ulkemizde ve dunyada yaslanan nufus ile birlikte yogun bakim tedavi gereksinimlerinin ve yogun bakim maliyetlerinin artmasi beklenmektedir. Tele-yogun bakim unitesi (Tele-YBU) uygulamalari kritik hastalarin takip ve tedavilerinin uzaktan duzenlenmesine, mevcut kaynaklarin verimli kullanimina imkan saglayarak yeni bir cozum araci olabilir. Tele-YBU programlari sayesinde yogun bakim uzmanlarinin yer ve zaman sinirlamasi olmadan ulkedeki tum yogun bakim yataklarina ulasabilecegi, hastalardan gelen tum verileri elektronik kayit sistemleri ile degerlendirebilecegi ve bu veriler isiginda hastalara kanita dayali en iyi tedavi onerilerini sunabilecekleri ongorulmektedir. Ancak Tele-YBU’nun kullanilmasi sirasinda karsilasabilecek altyapi yetersizlikleri, hasta-hekim, hekim-hasta yakini iliskisinin bozulmasinin yaratabilecegi problemler, hasta verilerinin korunmasi, depolanmasi ile ilgili guclukler, yasal mevzuat ve gorev tanimlarinin eksikligi gibi problemler bu yeni cozum stratejisinin potansiyel yararinin onune gecebilir. Bu derleme, Tele-YBU konusunda bilgilendirme, ulkemizde Tele-YBU uygulanirsa bu konudaki firsatlarimiza, eksikliklerimize ve kisitlamalarimiza dikkat cekmek ve bu eksikliklerin tamamlanmasi icin gerekli adimlarin atilmasini saglamak amaciyla yazilmistir.

Communication and role clarity inform TeleICU use: a qualitative analysis of opportunities and barriers in an established program using AACN framework

BackgroundUnderstanding the use of tele-intensive care unit (ICU) services is an essential component in evaluating current practice and informing future use as the adoption and application of teleICU services expands. We sought to explore if novel ways to utilize teleICU services can emerge within an established, consulting-style teleICU model considering the program’s flexible, provider-driven operation.MethodsThis was a qualitative study of one teleICU/hospital dyad using semi-structured interviews from a convenience sample of ICU (n = 19) and teleICU (n = 13) nurses. Interviews were analyzed using directed content analysis to identify themes that describe their experiences with teleICU using a deductive codebook developed from an expert consensus (American Association of Critical Care Nurses) AACN statement on teleICU nursing.ResultsThree themes were identified through the qualitative content analysis: [1] nurses described unique teleICU knowledge, including systems thinking and technological skills, [2] the teleICU partnership supported quality improvement initiatives, and [3] elements of the work environment influenced perceptions of teleICU and its use. When elements of the work environment, such as effective communication and role clarity, were not present, teleICU use was variable.ConclusionsFlexible, provider-driven approaches for integrating teleICU services into daily practice may help define the future use of the teleICU model’s applicability. Future work should focus on the importance of effective communication and role clarity in integrating the emerging teleICU services into teleICU/ICU practice.

Tele-medicine, tele-rounds, and tele-intensive care unit in the COVID-19 pandemic

The COVID-19 pandemic has caused a worldwide health crisis, laying stress on existing health-care systems and causing an unprecedented financial crisis. In this situation, provision of homogenized, evidence-based care by all levels of health-care providers, including those in a low-resource setting, is of paramount importance. As a specialized offshoot of Tele-medicine, Tele-intensive care unit (Tele-ICU) offers an innovative solution in the care of critically ill COVID-19 patients, by off-site clinicians, using audio, video, electronic, and tele-communication links to leverage technical, informational, and clinical resources. Tele-ICU also helps overcome the shortage of expertise like intensivists in these settings and helps to take the clinical expert to the patient bedside by remote monitoring and supervision. Telemedicine applications can be classified into four basic types, according to the mode of communication, timing of the information transmitted, the purpose of the consultation, and the interaction between the individuals involved-be it doctor-to patient/caregiver or doctor to doctor. The benefits and concerns of tele-medicine have been described in detail.

Telemedicine in Intensive Care Units: Protocol for a Scoping Review.

BackgroundTelemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account.ObjectiveWe present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case.MethodsWe have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021.ResultsThe preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts.ConclusionsThe results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified.International Registered Report Identifier (IRRID)DERR1-10.2196/19695

Tele-ICUs for COVID-19: A Look at National Prevalence and Characteristics of Hospitals Providing Teleintensive Care.

PurposeAmidst the COVID‐19 outbreak, the use of intensive care unit telemedicine (tele‐ICUs) may be one mechanism to provide patient care, particularly in rural parts of the United States. The purpose of this research was to inform hospital decision makers considering tele‐ICUs, policy makers weighing immediate and longer‐term funding and reimbursement decisions relative to tele‐ICU care, and researchers conducting future work evaluating tele‐ICUs.MethodsWe compared hospitals that reported providing teleintensive care to hospitals that reported not providing teleintensive care in the 2018 American Hospital Association Annual Survey (AHAAS). Differences between groups were tested using Pearson's chi‐square (categorical variables) and t‐tests (continuous variables) using 0.05 as the probability of Type 1 error. The study sample included all US short‐term, acute care hospitals that responded to the AHAAS in 2018. Our key variable of interest was whether a hospital reported having any tele‐ICU capabilities in the 2018 AHAAS. Other factors evaluated were ownership, region, beds, ICU beds, outpatient visits, emergency department visits, full‐time employees, and whether a hospital was rural, a critical access hospital, a major teaching hospital, or part of a health system.FindingsLarger, not‐for‐profit, nonrural, noncritical access, teaching hospitals that were part of a health system, particularly in the Midwest, were more likely to have tele‐ICUs. Over one‐third of hospital referral regions (HRRs) had zero hospitals with tele‐ICUs, 4 had all hospitals with tele‐ICU, and the median percent of hospitals with tele‐ICU by HRR, weighted by outpatient visits, was 11.3%.Conclusions and ImplicationsWe found wide variation in the prevalence of tele‐ICUs across HRRs and states. Future work should continue the evaluation of tele‐ICU effectiveness and, if favorable, explore the variation we identified for improved access to teleintensive care.

Tele-Intensive Care Unit Networks: A Viable Means for Augmenting Critical Care Capacity in India for the COVID Pandemic and Beyond

The COVID-19 pandemic has enormously stressed global healthcare systems compelling new approaches to care, especially by leveraging telehealth. In India, the timely release of the Telemedicine Practice Guidelines by the Government has enabled health providers to deliver essential medical evaluation, diagnosis, and triage remotely. Patients with COVID-19 present with a range of symptoms, and some need intensive care. The management of critically ill patients is resource-intensive and requires partnership between humans and machines. Monitoring vital physiology is key to effective critical care. In many countries, including India, the distribution of intensivists is skewed and tends to be predominantly based in urban tertiary care hospitals. Hospitals without on-site intensivists may benefit from tele-intensive care unit (ICU) services wherein electronic systems connect ICU patient data with intensivists at remote locations as part of a collaborative network. The tele-intensivists provide real-time data and audiovisual monitoring, diagnostic, and intervention services and work together with bedside teams bridging the critical care gap. This article is a practical guide for the logistics of telemedicine-based critical care in India for patients with COVID-19 and other conditions. In addition, this paper also suggests methods to expedite care. Information is provided for immediate use by physicians who have not practiced telemedicine in the ICU. As the number of patients affected increases around India rapid deployment of tele-ICU services will be essential to save lives. Caregiver stress can be minimized by remote care providers who can assist at any time.

Answering the Call: Impact of Tele-ICU Nurses During the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic has exacerbated staffing challenges already facing critical care nurses in intensive care units. Many intensive care units have been understaffed and the majority of nurses working in these units have little experience. To describe how the skilled tele-intensive care unit nurses in our health system quickly changed from a patient-focused strategy to a clinician-focused approach during the coronavirus disease 2019 crisis. We modified workflows, deployed home workstations, and changed staffing models with the goal of providing additional clinical support to bedside colleagues while reducing exposure time and conserving personal protective equipment for those caring for this highly contagious patient population. The unit changed focus and granted more than 300 clinicians access to technology that enabled them to care for patients remotely, added nearly 200 mobile carts, and allowed more than 20 tele-intensive care unit nurses to work from home. Tele-intensive care unit nursing provided clinical knowledge to the nurses covering current and expanded critical care units. Using technology, virtual rounding, and increased collaboration with nurses, tele-intensive care unit nursing minimized the risk to bedside nurses while maintaining a high level of care for patients. Tele-intensive care unit nurses provided a proactive, holistic approach to caring for critically ill patients via camera as part of their routine workflow. In addition, during the coronavirus disease 2019 pandemic, these nurses created a new strategy in virtual health care to be implemented during a crisis.

Responding to COVID-19: The UW Medicine Information Technology Services Experience.

Background UW Medicine was one of the first health systems to encounter and treat COVID-19 patients in the United States, starting in late February 2020. Objective Here we describe the rapid rollout of capabilities by UW Medicine Information Technology Services (ITS) to support our clinical response to the COVID-19 pandemic and provide recommendations for health systems to urgently consider, as they plan their own response to this and potentially other future pandemics. Methods Our recommendations include establishing a hospital incident command structure that includes tight integration with IT, creating automated dashboards for incident command, optimizing emergency communication to staff and patients, and preparing human resources, security, other policies, and equipment to support the transition of all nonessential staff to telework. We describe how UW Medicine quickly expanded telemedicine capabilities to include most primary care providers and increasing numbers of specialty providers. We look at how we managed expedited change control processes to quickly update electronic health records (EHR) with new COVID-19 laboratory and clinical workflows. We also examine the integration of new technology such as tele–intensive care (ICU) equipment and improved integration with teleconferencing software into our EHR. To support the rapid preparation for COVID-19 at other health systems, we include samples of the UW Medicine's COVID-19 order set, COVID-19 documentation template, dashboard metric categories, and a list of the top 10 things your health care IT organization can do now to prepare. Conclusion The COVID-19 response requires new and expedited ways of approaching ITS support to clinical needs. UW Medicine ITS leadership hope that by quickly sharing our nimble response to clinical and operational requests, we can help other systems prepare to respond to this public health emergency.