# title
Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study (Preprint)

# abstract
BACKGROUND

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.

OBJECTIVE

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.

METHODS

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 nonCOVID-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 nonCOVID-19 units to provide urgent, emergent, and code blue support to all ICUs.

RESULTS

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.

CONCLUSIONS

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.

# authors[].organizations[].label
Center for Health Organization Transformation

# authors[].organizations[].label
Institute for Engineering Education and Innovation

# authors[].organizations[].label
Institute for Science, Technology, and Public Policy

# authors[].organizations[].label
Center for Remote Health Technologies and Systems

# authors[].organizations[].label
Texas A&M Engineering Experiment Station (TEES)

# authors[].organizations[].label
Bush School of Government and Public Service

# authorList[]
Dhala, A., Sasangohar, F., Kash, B., Ahmadi, N., & Masud, F.