Tele-ICU Care and the COVID-19

Pandemic
Ashley Walton
Purpose of the
● When the Covid-19 pandemic started the health
organization, Atrium Health started

Study implementing tele-intensive care units into

many more of their facilities. The objective of
this article is to explain how that impacted the
facilities and bettered the skills of the nurses
and other HCPs caring for patients with
Covid-19.
VCC Defined and
● VCC- virtual critical care
● VCCs have been providing nursing care in 10

Uses different hospitals throughout south eastern

United States, and in 16 ICUs, since 2013.
● Tools of VCCs include:
○ Real time, 2-way audio
○ High definition video communication
● “The VCC team provides critical care coverage
for adult patients 24 hours a day, every day. The
additional layer of critical care expertise,
monitoring, and communication aids bedside
ICU nursing staff.”
Pictures of VCC
Background
● Before the pandemic, staffing was already an
issue in ICUs.
● “According to an internal survey (of Atrium
Health) of 164 ICU nurses in our health system
in 2019, 39% of nurses at the bedside has less
than 2 years of nursing experience and 73% had
less than 5 years experience.”
● With the surge of COVID-19 cases many
non-ICU locations were designated to care for
critically ill patients.
● Personal Protective Equipment (PPE) supply
has not been meeting the demand.
● On average nurses spend 33% of their shifts in
patients room, which increased concern about
transmission and safety of nurses.
● Tele-ICU nursing was thought to be a key
advantage and reasonable approach to care for
patients and still keep staff safe.
Methods used by
● Atrium Health modified the way their ICUs
worked in several ways

Atrium Health
○ Altered work flows throughout the day
○ Allowed nurses at high risks to work from home
○ Produced the goal of having additional support
for bedside nurses
○ Allowed access to tele-ICU technology to over
300 clinicians
■ Physicians
■ Nurses
■ Pharmacists
■ Respiratory Therapists
○ Added approximately 200 mobile carts
Expansion of VCC
● In the beginning of the pandemic 3 hospitals in
Atrium Health facilities quickly expanded their
ICU capacity with the help of VCC from 43% to
175%
● Over 300 additional members of the health care
team were granted access to the software used
for the tele-ICU.
● The expansion of members who had access to
VCC allowed virtual assessment and
communication with patients who were in
isolation, therefore decreasing the time
members of the health care team spent in
patient rooms
● The VCC also allowed nurses who were high risk
due to health issues of their own to work from
home and have less exposure to direct patient
care
Changes to the
● “During the pandemic, however, VCC nurses
have shifted their focus to provide not only a

Structure of Critical proactive, holistic approach to caring for

critically ill patients but also to support and

Care Nursing protect bedside nurses caring for patients in

isolation. Specific aims included reducing
unnecessary time spent in rooms of patients
with COVID-19, minimizing bedside staff
exposure, and facilitating communication
among the health care team.”
Rules of the VCC
● VCC nurses communicates with the bedside
nurse at the start of each shift to form the

Nurse in Order to ●
patient rounding schedule
The VCC nurse is responsible for visual patient

Reduce Time Spent rounding every other hour, or more frequently if

necessary
in Isolation Rooms ● Assessment of IV sites, infusions, and other
equipment
for Bedside Nurses ● During significant procedures VCC nurses are
present on camera to monitor the patient,
document the time-out, and take detailed notes
of the actions made
● VCC nurses are also able to communicate the
needs of bedside nurses that are in full PPE
when in the isolation room to someone outside
of the room
Results Regarding
● Increasing the use of VCC allowed the reduction
of exposure for bedside nurses.

the Changes Made ● This also preserved a high level of care for high
acuity patients.
Clinical Support
● Due to the need to expand the care of critically
ill patients, nurses without ICU experience were
called upon to care for these patients, VCC
allowed these nurses to have experienced ICU
nurses on hand for support and advice.
● VCC also had clear access to tracking all ICU
beds and patients that were being tested and
those that came back positive, this allowed for
informed decision to be made regarding
designation of supplies, equipment, and staff
based on capacity.
Psychosocial
● Additional support that was provided by VCC
nurses eased the minds of many of bedside

Support nurses, especially those with little to no ICU

experience that were pulled to care for COVID
patients.
● VCC nurses are also able to provide emotional
assurance and support to the patient that their
nurses, respiratory therapists, physicians are on
the way to help.
Conclusion
● “By increasing the availability of technology and
modifying VCC nursing support, Atrium Health
could manage shortages of critical care nursing
staff while maintaining the care standards that
define the profession.”
● The quick growth of telemedicine throughout
the country during this pandemic has caused
tele-ICU nursing to evolve as well to meet the
needs of the staff and patients.
● “Early anecdotal feedback from bedside nurses,
physicians, and leaders of this process has
been favorable, and this experience has shown
the versatility of the tele-ICU, including the
ability to adapt to situations ranging from
everyday tele-critical care support to crisis
management and most importantly, the value of
tele-ICU nurses can provide to their bedside
colleagues.”
Citation
● Arneson, S. L., Tucker, S. J., Mer ier, M., & Singh,
J. (2020). Ansering the Call: Impact of Tele-ICU
Nurses During the COVID-19 Pandemic. Critical
Care Nurse, 40(4), 25-31.
doi:10.4037/ccn2020126