TeleICU is very much like a typical ICU workflow―the difference is that the critical care physician is remote. Like other hospital ICU physicians, teleIntensivists begin each shift by rounding with the patient care team and discussing each patient, classifying them by acuity:
- Patients with acute needs that have potential issues and challenges
- Patients that can be downgraded or transferred out of the ICU
- Patients in the “grey area” where the trajectory of the illness is less clear
Those patients identified with potential problems or increased acuity due to their diagnoses and progressing illness can be escalated for a full in-depth evaluation by the teleIntensivist and on-site care teams. The goal is to proactively assess and treat patients before decompensation occurs.
When an emergency occurs in the ICU, the patient care team can request a consult (similar to paging a doctor who may be elsewhere in the hospital.) TeleIntensivists can run codes, talk the care team through procedures, as well as speak directly to patients and/or their families to help with difficult care decisions.
For many organizations, finding nighttime coverage is a challenge. Some teleIntensivists specialize as nocturnalists, and support the on-site clinical team and cover the ICU overnight.