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

Abstract

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.

A co-design of clinical virtual care pathways to engage and support families requiring neonatal intensive care in response to the COVID-19 pandemic (COVES study)

“…In the beginning of the pandemic and presence restrictions, families joined rounds virtually through technologies like FaceTime and Zoom, yet due to the critical nature of this environment and need for high quality infection control practices, any equipment (e.g., computer for Zoom) could not enter patient rooms. This barrier was shared across adult ICUs, which became a greater issue as many hospitals restricted family presence entirely ( Dhala et al, 2020 ). Expediating the rollout of CHN Connect enhanced virtual rounds significantly, as it allowed families and other HCPs to easily join virtual rounds, enhanced patient privacy, and enhanced care through more effective communication.…”

“…Expediating the rollout of CHN Connect enhanced virtual rounds significantly, as it allowed families and other HCPs to easily join virtual rounds, enhanced patient privacy, and enhanced care through more effective communication. Other critical care areas utilized similar systems/platforms to facilitate presence when physical presence of families was restricted, which was reported to be incredibly impactful to the whole family unit specifically with their mental wellbeing ( Dhala et al, 2020 ).…”

Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR)

“…This remote ICU monitoring environment with embedded advanced telehealth capabilities captures real-time continuous physiological data on all ICU patients (including those with COVID-19) and provides an opportunity to develop predictive analytical tools to proactively identify critical risk factors and anticipate patient decompensation. The vICU platform at Houston Methodist was rapidly expanded following the COVID-19 pandemic [ 13 ]. Thus, vICU information is being integrated into CURATOR to broaden research perspectives and enrich the case histories with streaming physiologic data captured in real-time.…”

Perspectives of Remote Volunteer Palliative Care Consultants During COVID: A Qualitative Study

“…The COVID-19 pandemic fundamentally altered the ways in which many fields of medicine deliver care, bringing about a number of changes to workflow born from the greater need for healthcare resources and safety precautions to limit the spread of COVID-19. [1][2][3][4][5][6][7][8][9][10] New York City experienced the first major United States COVID-19 surge during the spring of 2020. 11 The surge required New York City's largest hospital, Columbia University Irving Medical Center (CUIMC)/NewYork-Presbyterian (NYP), to rapidly adapt in order to meet the needs of their patient population.…”