Tele-critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee

Sanjay Subramanian, MD, MMM; Jeremy C. Pamplin, MD, FCCM, FACP; Marilyn Hravnak, PhD, RN, ACNP-BC, FCCM, FAAN; Christina Hielsberg, MA; Richard Riker, MD; Fred Rincon, MD, MSc, MB.Ethics; Krzysztof Laudanski, MD, PhD, FCCM; Lana A. Adzhigirey, MSN, RN, CPHQ; M. Anas Moughrabieh, MD, MPH; Fiona A. Winterbottom, DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN; Vitaly Herasevich, MD, PhD, FCCM

Disclosures

Crit Care Med. 2020;48(4):553-561. 

In This Article

Abstract and Introduction

Abstract

Objectives: In 2014, the Tele-ICU Committee of the Society of Critical Care Medicine published an article regarding the state of ICU telemedicine, one better defined today as tele-critical care. Given the rapid evolution in the field, the authors now provide an updated review.

Data Sources and Study Selection: We searched PubMed and OVID for peer-reviewed literature published between 2010 and 2018 related to significant developments in tele-critical care, including its prevalence, function, activity, and technologies. Search terms included electronic ICU, tele-ICU, critical care telemedicine, and ICU telemedicine with appropriate descriptors relevant to each sub-section. Additionally, information from surveys done by the Society of Critical Care Medicine was included given the relevance to the discussion and was referenced accordingly.

Data Extraction and Data Synthesis: Tele-critical care continues to evolve in multiple domains, including organizational structure, technologies, expanded-use case scenarios, and novel applications. Insights have been gained in economic impact and human and organizational factors affecting tele-critical care delivery. Legislation and credentialing continue to significantly influence the pace of tele-critical care growth and adoption.

Conclusions: Tele-critical care is an established mechanism to leverage critical care expertise to ICUs and beyond, but systematic research comparing different models, approaches, and technologies is still needed.

Introduction

In 2014, the Tele-ICU Committee of Society of Critical Care Medicine (SCCM) published a review of tele-ICU services[1] and now provides updates on its evolution. Today, clinicians use tele-ICU technologies and services in ways not previously considered. Consequently, the committee recommends a new term to describe technology-enabled critical care services to replace existing terms such as tele-ICU, ICU telemedicine, and others—tele-critical care (TCC). This term accommodates the concept that TCC services can be provided to locations beyond the physical confines of an ICU, or even a hospital. This article provides insight into TCC's evolving prevalence, functions, emerging trends, technologies, new applications, outcomes, and barriers. To clarify terminology, the entity providing TCC services is referred to as the "remote site," and the connected services recipient where care is physically provided as the "local site," regardless of geographic proximity.

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