Dhala Atiya, Sasangohar Farzan, Kash Bita, Ahmadi Nima, Masud Faisal
Department of Surgery, Houston Methodist Hospital, Houston, TX, United States.
Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.
J Med Internet Res. 2020 Sep 3;22(9):e20143. doi: 10.2196/20143.
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.
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.
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.
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.
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.
新冠疫情使得高传染性疾病重症监护病房（ICU）的空间需求迅速增加。在休斯顿卫理公会医院（HMH），新冠疫情爆发期间启用了虚拟重症监护病房（vICU）。
本文旨在详细介绍vICU的创新调整和快速扩展情况，这些举措是为了在疫情期间实现以患者为中心的解决方案，同时保护医护人员和患者家属。
原计划的vICU实施工作进行了调整，以满足新冠ICU转换的新需求，包括改变分阶段推出时间、虚拟和现场人员配置以及应用范围。由于医院大部分重症监护医师被重新调配到迅速扩充的新冠ICU，非新冠ICU由心血管外科医生、心脏病专家、神经外科医生和急症外科医生管理。HMH扩大了vICU项目，以填补非新冠科室新出现的重症监护专业知识空白，为所有ICU提供紧急、突发和急救支持。
通过Consultant Bridge应用程序进行的虚拟家属探视、姑息治疗以及为新冠患者提供的专科会诊，体现了vICU实施的成功调整。新冠患者为防止感染传播而与家人隔离，他们能够通过虚拟方式看到并听到亲人的声音，这增强了这些患者的心理和情绪状态。许多家属对能够与亲人见面和交谈表示感激。vICU还保护了被分配到新冠科室的医护人员和专家，减少了接触并节省了个人防护装备。
在休斯顿卫理公会医院快速推出vICU期间，远程重症监护已成为提供重症监护专业知识的有利机制。患者、家属和医生的总体反馈都支持继续采用vICU护理；然而，需要进一步研究来考察远程重症监护创新应用对重症患者治疗的影响。
