Houston Methodist Hospital, Houston, Texas, US.
Equum Medical, New York, New York, US.
Methodist Debakey Cardiovasc J. 2023 Aug 1;19(4):4-16. doi: 10.14797/mdcvj.1247. eCollection 2023.
A long-standing shortage of critical care intensivists and nurses, exacerbated by the coronavirus disease (COVID-19) pandemic, has led to an accelerated adoption of tele-critical care in the United States (US). Due to their complex and high-acuity nature, cardiac, cardiovascular, and cardiothoracic intensive care units (ICUs) have generally been limited in their ability to leverage tele-critical care resources. In early 2020, Houston Methodist Hospital (HMH) launched its tele-critical care program called Virtual ICU, or vICU, to improve its ICU staffing efficiency while providing high-quality, continuous access to in-person and virtual intensivists and critical care nurses. This article provides a roadmap with prescriptive specifications for planning, launching, and integrating vICU services within cardiac and cardiovascular ICUs-one of the first such integrations among the leading academic US hospitals. The success of integrating vICU depends upon the (1) recruitment of intensivists and RNs with expertise in managing cardiac and cardiovascular patients on the vICU staff as well as concerted efforts to promote mutual trust and confidence between in-person and virtual providers, (2) consultations with the bedside clinicians to secure their buy-in on the merits of vICU resources, and (3) collaborative approaches to improve workflow protocols and communications. Integration of vICU has resulted in the reduction of monthly night-call requirements for the in-person intensivists and an increase in work satisfaction. Data also show that support of the vICU is associated with a significant reduction in the rate of Code Blue events (denoting a situation where a patient requires immediate resuscitation, typically due to a cardiac or respiratory arrest). As the providers become more comfortable with the advances in artificial intelligence and big data-driven technology, the Cardiac ICU Cohort continues to improve methods to predict and track patient trends in the ICUs.
长期以来，重症监护医师和护士的短缺，加上冠状病毒病（COVID-19）大流行，导致美国加速采用远程重症监护。由于其复杂和高度集中的性质，心脏、心血管和心胸重症监护病房（ICU）通常在利用远程重症监护资源方面能力有限。2020 年初，休斯顿卫理公会医院（HMH）推出了名为虚拟 ICU（vICU）的远程重症监护计划，以提高其 ICU 人员配备效率，同时为现场和虚拟重症监护医师和重症监护护士提供高质量、持续的服务。本文提供了一个路线图，其中包含了在心脏和心血管 ICU 中规划、启动和整合 vICU 服务的具体规范，这是美国领先学术医院中首批此类整合之一。整合 vICU 的成功取决于以下几点：（1）在 vICU 工作人员中招募具有管理心脏和心血管患者专业知识的重症监护医师和注册护士，并共同努力促进现场和虚拟提供者之间的相互信任和信心；（2）与床边临床医生协商，确保他们对 vICU 资源的优点有充分的了解；（3）采取协作方法改进工作流程协议和沟通。整合 vICU 已导致现场重症监护医师每月夜间呼叫需求减少，并提高了工作满意度。数据还表明，对 vICU 的支持与蓝码事件（表示患者需要立即进行复苏，通常是由于心脏或呼吸骤停）的发生率显著降低有关。随着提供者对人工智能和大数据驱动技术的进步越来越熟悉，心脏 ICU 队列继续改进预测和跟踪 ICU 中患者趋势的方法。
