ABSTRACT

The virtual or remote intensive care unit is a redesigned model of care that uses state-of-the-art technology to
leverage the expertise and knowledge of experienced caregivers over a large group of patients in multiple
intensive care units.This review article aims to elaborate about virtual ICU, examine the impact of
telemedicine ICU, technological infrastructure, benefits, potential, safety, and quality.

Virtual ICU ( telemedicine) was first reported in 1977.The virtual or remote

intensive care unit is a redesigned model of care that uses state of art technology
to leverage the expertise and knowledge of experienced caregivers over a large
group of patients in multiple intensive care units. The virtual intensive care unit
uses sophisticated telemedicine technology and a remote team of critical care
experts, including nurses, to provide continuous monitoring, assessment, and
interventional services to a large number of patients across multiple ICUs. The
registered nurse working in this environment, or eRN, is an expert clinician
familiar with evidence based clinical initiatives that need to occur at the bedside
to optimize outcomes for patients. The eRN assists the bedside team by providing
a second layer of quality, control and safety. As the use of this technology
continues to immerge, a new dimension for critical care nursing practice is
emerging that has progressive implications for the future. The virtual ICU is built
on a technological infrastructure and clinical expertise to improve operational
performances. An early advantage to implementing a virtual ICU is that it
emphasis a health system to evaluate current operational processes and
technological infrastructures to implement decision support tools. A safer
healthcare environment emerges through a comprehensive evaluation of all
patient care aspects. The past several years have seen a great increase in the
number of health systems adopting this care model. These health systems have
increased our understanding of both the ability of this new care model to improve
clinical outcomes and the clinical processes that are required to achieve program
quality goals. Health systems have begun to expand the scope of activities of the
remote care team, capitalizing on the potential of this new operational and
technology platform to revolutionize scarce personnel and achieve increases in
both clinical effectiveness and provider efficiency. The demand for critical care
has already and will further outpace the supply of intensives in the near future
.ICU telemedicine providers typically use electronic medical records combined
with audiovisual technologies to assist bedside caregivers in patient care
activities, including best practice adherence, monitoring of clinical stability, and
the creation and execution of care plans. Today, ICU telemedicine programs are
more widespread, covering at least 15% of ICU beds in the U.S. ICUs that make
use of telemedicine are widely dispersed geographically and serve communities
of all sizes, including both rural and urban settings. The most common model in
this regard is the centralized telemedicine unit, which uses a hub-and-spoke
model from which critical care services originate .The hub or center is the remote
site from which a multidisciplinary team (including variable combinations of
intensivists, nurses, advanced practitioners, pharmacists, therapists, and
administrative staff) provides off site monitoring for critically ill patients.
Alternatively, the decentralized model uses a reverse hub and spoke model, in
which there is no central monitoring facility. In this model, computers equipped
with audiovisual technology are also located at sites of patient care, but the
remote monitoring occurs from sites of convenience for individual remote care
providers, such as physician offices or homes. The difference between ICU
telemedicine program and bedside providers varies widely across three primary
domains that are time, reactivity, and scope. For instance, the ICU telemedicine
team may provide services intermittently or in a continuous fashion up to 24
hours per day. ICU telemedicine programs may implement a reactive model, in
which telemedicine providers respond to automated alerts for worrisome trends
that may not yet be recognized by the bedside providers or to requests for
involvement from bedside providers

CONCLUSION
ICU telemedicine represents an organization's innovation that has the potential to
improve access and quality of critical care. It is crucial to recognize the wide
range of implementation strategies for ICU telemedicine when examining existing
evidence about its effects on the quality and efficiency of critical care. It is also
important to account for local culture and resources when deciding whether to
implement the intervention in a particular healthcare system. As telemedicine ICU
programs are expanding and growing nationally, Our challenge is to ensure that
these new capabilities do not undercut essential components of medicine and
unintentionally cause harm.