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In 2013, the American Association of Critical-Care Nurses recognized TCC as a specialty and published guidelines for nursing practice. Future plans for this TCC system include establishing a regionalized logistics center to improve patient flow and care coordination, incorporating advanced practice providers and critical care fellows into the care team, and providing examples to new ICUs and emergency departments.Ĭritical care nurses are an integral component of TCC programs, practicing at both TCC re-mote and local sites, and their collaboration is essential. Some quality initiatives supported by the Barnes-Jewish Hospital network have included cardiac surgery rapid extubation protocols, best practice compliance, and mentoring newly hired nurses, with positive results. 5 The TCC service has brought structure, standardization, collaboration, and improved patient safety to these community hospital units, while case complex-ity and volume have shown an upward trend.Ĭare quality can be individualized to each institution in the TCC network and can include more than ICU mortality and length-of-stay metrics.
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After TCC implementation, they used analytics derived from the TCC service to identify areas of deficiency in each local ICU, and then developed a site-specific “hot list”-a nurse-driven protocol to drive change successfully. Louis, Missouri, USA, evaluated their observed and expected ICU mortality and length of stay ratios before TCC implementation. TCC fosters a detailed self-assessment before implementation and continuously thereafter to leverage opportunities for growth while maintaining current areas of excellence. This paradigm shift in care delivery for both locations brings a host of complex challenges, primarily the comprehension and assimilation of highly advanced technology into daily com-munity ICU care practice, followed by effective communication with the bedside team. 4 In some scenarios, the TCC model links tertiary center remote sites to community hospital local sites. The relationship between the TCC-originating (remote) site and the TCC-receiving (local) site is important in developing a one-team approach that delivers appropriate, responsive, and consistent care of tangible value woven into exemplary bedside practice. Hybrid Model Perspective (Academic/Community) This article outlines various perspectives on the successes and challenges of TCC in improving care quality as related by members of the SCCM Tele-ICU Committee.
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Telemedicine in critical care has been intensely watched and widely debated in the literature. Winterbottom DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN Majdi Hamarshi, MD Christopher Palmer, MD, FACEP Marilyn Hravnak, RN, PhD, ACNP-BC, FCCM, FAAN Adzhigirey, RN, MN, CPHQ Jayashree Raikhelkar, MD Ralph J.