Rapid Implementation of Telecritical Care Support During a Pandemic: Lessons Learned During the Coronavirus Disease 2020 Surge in New York City

Abstract

Objectives: We describe the key elements for a New York City health system to rapidly implement telecritical care consultative services to a newly created ICU during the coronavirus disease 2020 patient surge.

Design: This was a rapid quality-improvement initiative using public health decrees, a HIPAA-compliant and device-agnostic telemedicine patform, and a group of out-of-state intensivist volunteers to enhance critical care support. Telecritical care volunteers initially provided on-demand consults but then shifted to round twice daily with housestaff in a 12-bed newly created ICU.

Setting: A 457-bed safety net hospital in the Bronx, NY, during the pandemic.

Subjects: The 12-bed newly created ICU was staffed by a telecritical care attending, a cardiology fellow, and internal medicine residents.

Intervention: Prior to the intervention, the ad hoc ICU was staffed by a cardiology fellow as the attending of record, with critical care support on demand. The intervention involved twice daily rounding with an out-of-state, volunteer intensivist.

Measurements and main results: Volunteers logged 352 encounters. Data from 26 unique encounters during the initial on-demand consult pilot study of tele-ICU support were recorded. The most common interventions were diagnostic test interpretation, ventilator management, and sedation change. The majority of housestaff felt the new tele-ICU service improved the quality of care of patients and decreased anxiety of taking care of complex patients. Likewise, the majority of volunteers expressed making significant alterations to care, and 100% believed critical care input was needed for these patients. The largest lessons learned centered around mandating the use of the telecritical care volunteers and integration into a structured format of rounding.

Conclusions: The need for rapid implementation of ICUs during a major public health crisis can be challenging. Our pilot study supports the feasibility of using an out-of-state telecritical care service to support ICUs, particularly in areas where resources are limited.

Keywords: coronavirus disease 2019; critical care; information technology; intensive care units; telehealth; telemedicine.

Figure 1.

Illustration of the admitted daily occupancy and daily ICU admissions by coronavirus disease (COVID) status.