Integrating a Virtual ICU with Cardiac and Cardiovascular ICUs: Managing the Needs of a Complex and High-Acuity Specialty ICU Cohort

Abstract

A long-standing shortage of critical care intensivists and nurses, exacerbated by the coronavirus disease (COVID-19) pandemic, has led to an accelerated adoption of telecritical care in the United States (US). Due to their complex and high-acuity nature, cardiac, cardiovascular, and cardiothoracic intensive care units (ICUs) have generally been limited in their ability to leverage tele-critical care resources. In early 2020, Houston Methodist Hospital (HMH) launched its tele-critical care program called Virtual ICU, or vICU, to improve its ICU staffing efficiency while providing high-quality, continuous access to inperson and virtual intensivists and critical care nurses. This article provides a roadmap with prescriptive specifications for planning, launching, and integrating vICU services within cardiac and cardiovascular ICUs-one of the first such integrations among the leading academic US hospitals. The success of integrating vICU depends upon the (1) recruitment of intensivists and RNs with expertise in managing cardiac and cardiovascular patients on the vICU staff as well as concerted efforts to promote mutual trust and confidence between in-person and virtual providers, (2) consultations with the bedside clinicians to secure their buy-in on the merits of vICU resources, and (3) collaborative approaches to improve workflow protocols and communications. Integration of vICU has resulted in the reduction of monthly night-call requirements for the in-person intensivists and an increase in work satisfaction. Data also show that support of the vICU is associated with a significant reduction in the rate of Code Blue events (denoting a situation where a patient requires immediate resuscitation, typically due to a cardiac or respiratory arrest). As the providers become more comfortable with the advances in artificial intelligence and big data-driven technology, the Cardiac ICU Cohort continues to improve methods to predict and track patient trends in the ICUs. PATIENT POPULATION DESCRIPTION Medicine, general surgery and neurology patientsRespiratory failure secondary to pneumonia, status post complex abdominal surgery, cerebrovascular accident status post intervention. Preoperative cardiovascular, cardiac and vascular surgery patientsUnstable patients being evaluated for aortic dissection repair or cardiac surgery with or without devices. Heart transplant patient on inotropes or with intra-aortic balloon pump (IABP) or Impella. Cardiovascular and thoracic surgery patientsCoronary artery bypass, valve repair or replacement, cardiac tumor resection, pneumonectomy, lobectomy, esophagectomy, aortoesophageal repair. Complicated and combined vascular surgery patientsPost left ventricular assist device, heart transplant patients, aortic dissection repair (endovascular or open), superior vena cava syndrome repair, heart and/or lung transplant or combined with liver or kidney transplant. Congestive heart failure patientsAcute decompensated heart failure, including those with or without cardiac devices; any patient requiring i...

Past, present, and future of sustainable intensive care: narrative review and a large hospital system experience

“…To meet escalating critical care needs, HM also launched a systemwide virtual ICU (vICU) program [ 53 , 54 ], with potential low-carbon implications. This state-of the-art facility leverages the digital transformation of in-hospital care to incorporate remote monitoring and interactive video conferencing.…”