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Citation: Chernikova D. Tele-critical health care: Lessons learned from the pandemic.Jr.med.res. 2021; 4(2):2. Chernikova © All
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Editorial
Tele-critical health care: Lessons learned from the pandemic.
Dr. Daryna Chernikova
Department of Cardiology, City Hospital, Kramatorsk, Ukraine.
International society for telemedicine and e-Health.
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].
References
[1] Subramanian S, Pamplin JC, Hravnak M, Hielsberg C, Riker R, Rincon F, et al. Tele-Critical Care: An update from the Society of Critical Care Medicine Tele-ICU Committee. Crit Care Med. 2020;48:553-61.
[2] Singh J, Green MB, Lindblom S, Reif MS, Thakkar NP, Papali A. Telecritical Care Clinical and Operational Strategies in Response to COVID-19. Telemed J E Health. 2021;27:261-68.
[3] Srinivasan SR. Tele-ICU in the Age of COVID-19: Built for This Challenge. J Nutr Health Aging. 2020;24:536-37.
[4] Schinköthe T, Gabri MR, Mitterer M, Gouveia P, Heinemann V, Harbeck N, Subklewe M. A Web- and App-Based connected care solution for COVID-19 In- and Outpatient Care: Qualitative study and application
development. JMIR Public Health Surveill. 2020 Jun 1;6:e19033.
[5] Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020 ;27:1132-35.
[6] Perez J, Niburski K, Stoopler M, Ingelmo P. Telehealth and chronic pain management from rapid adaptation to long-term implementation in pain medicine: A narrative review. Pain Rep. 2021;6:e912.
[7] Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020; 27:957-62.
[8] Krouss M, Allison MG, Rios S, Bringardner BD, Langston MD, Sokol SI,et al. Rapid Implementation of Telecritical Care Support During a Pandemic: Lessons learned during the Coronavirus Disease 2020 surge in
New York city. Crit Care Explor. 2020;2:e0271.
