Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit

2018 ◽  
Vol 42 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Michael P. Leovic ◽  
Hailey N. Robbins ◽  
Roman S. Starikov ◽  
Michael R. Foley
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery

scholarly journals Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study (Preprint)

2020 ◽  
Author(s):  
Atiya Dhala ◽  
Farzan Sasangohar ◽  
Bita Kash ◽  
Nima Ahmadi ◽  
Faisal Masud
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Care Physician ◽  
Rapid Expansion ◽  
Code Blue ◽  
Scope Of Application ◽  
Spread Of Infection ◽  
The Impact

BACKGROUND The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. OBJECTIVE The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. METHODS The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. RESULTS Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. CONCLUSIONS Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

scholarly journals Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study

10.2196/20143 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e20143
Author(s):  
Atiya Dhala ◽  
Farzan Sasangohar ◽  
Bita Kash ◽  
Nima Ahmadi ◽  
Faisal Masud
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Care Physician ◽  
Rapid Expansion ◽  
Code Blue ◽  
Scope Of Application ◽  
Spread Of Infection ◽  
The Impact

Background The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.

Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety

2018 ◽  
Vol 38 (3) ◽  
pp. 54-66 ◽  
Author(s):  
Lynn G. Mackinson ◽  
Juliann Corey ◽  
Veronica Kelly ◽  
Kristin P. O’Reilly ◽  
Jennifer P. Stevens ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Critical Care Nurses ◽  
Lessons Learned ◽  
Scope Of Practice ◽  
Clinical Expertise ◽  
Health Care Delivery Systems

A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants’ responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.

Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model

2001 ◽  
Vol 29 (10) ◽  
pp. 2007-2019 ◽  
Author(s):  
Richard J. Brilli ◽  
Antoinette Spevetz ◽  
Richard D. Branson ◽  
Gladys M. Campbell ◽  
Henry Cohen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Best Practice ◽  
Care Delivery ◽  
Practice Model

Noncardiovascular Disease and Critical Care Delivery in a Contemporary Cardiac and Medical Intensive Care Unit

2017 ◽  
Vol 34 (7) ◽  
pp. 537-543 ◽  
Author(s):  
Michael Goldfarb ◽  
Sean van Diepen ◽  
Mark Liszkowski ◽  
Jacob C. Jentzer ◽  
Isabel Pedraza ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Care Delivery ◽  
Medical Intensive Care

Abstract 19519: Closing the Cardiac Intensive Care Unit: Cost-Savings Associated with a “Closed” versus “Open” Model of Critical Care Delivery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Arun K Das ◽  
Jacqueline M Harden ◽  
Mathi M Ravichandran ◽  
Anton Lishmanov ◽  
Linda Raftery ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Unit Cost ◽  
Cardiac Intensive Care Unit ◽  
Closed Model ◽  
Cardiac Intensive Care ◽  
The Impact ◽  
Care Costs

Introduction: A recent AHA scientific statement highlighted the evolving complexity of critical care delivery for cardiac patients, and the emerging need for novel staffing models. In this document, a “closed” unit structure - in which a dedicated intensive care team treats all admitted patients - was specifically advocated. However, in light of escalating critical care costs within US hospitals, there is a pressing need to better understand the financial impact of different care platforms. Methods: In July 2013, our academic cardiac intensive care unit (CICU) was transitioned from an “open” to a “closed” model of care. In a before-and-after study design, consecutive admission records were reviewed from Aug 2012-Dec 2012 (“open” unit) and from Aug 2013-Dec 2013 (“closed” unit). Routinely collected financial and demographic data were examined, and the impact of case-mix index (CMI) on cost was evaluated. Results: In the “open” and “closed” models, there were 333 patient-visits accounting for 1,891 patient-days and 397 visits accounting for 2,558 patient-days, respectively. While demographics, payor mix, and fixed vs. variable cost distribution were unchanged (Table), the total cost-per-patient and cost-per-patient-day were lower within the “closed” CICU ($8,676 vs. $10,118 and $1,346 vs. $1,782, respectively) despite a greater average CMI (4.6 vs. 3.6). Total and 30d CICU readmission rates were also lower in the “closed” unit (Table). Readmissions in the "closed" unit resulted in greater cost-per-patient-day than new admits ($1,576 vs. $1,339). Conclusions: A “closed” CICU staffing model is associated with lower health care costs. This may be partly explained by lower CICU recidivism, but likely is multifactorial. Additional study will focus on the influence of resource use, critical care delivery to key sub-populations, and the development of effective strategies for further cost containment.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

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