title: Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
abstract: BACKGROUND
  Telemedicine-based "tele-intensive care unit" ("tele-ICU") solutions represent an increasingly popular hospital platform to provide ICU specialist expertise while remaining sensitive to healthcare costs. This side-by-side review directly compares the Centralized Monitoring and Virtual Consultant tele-ICU Models.
  
  
  METHODS
  We identified all publications in any language addressing the use and efficacy of centralized monitoring and virtual consultant tele-ICU systems through reviews of the PubMed, CINAHL, and Web of Science Web sites, corporate documents, corporate Internet sites, and discussions with corporate representatives. Of the 1,468 documents identified, 1,371 documents were excluded, with the 91 included documents addressing the following: clinical outcomes, 46 documents (enhanced guideline compliance, 5; mortality and length of stay, 28; and feasibility, 13); financial sustainability, 9 documents; and ICU staff workflow and acceptance, 36 documents. We performed qualitative comparative reviews of documents addressing technology, financial sustainability, clinical outcomes, and ICU staff workflow and acceptance.
  
  
  RESULTS
  The Centralized Monitoring tele-ICU Model showed improved mortality and/or length of stay and staff acceptance, particularly in rural or specific patient populations, likely because of the presence of integrated clinical information systems and analytics. However, there are high costs and unclear savings. The Virtual Consultant Model could not be adequately evaluated for effects on clinical outcomes or staff acceptance given minimal data. This model can be both portable and implemented at a lower cost profile but cannot integrate different data streams. Improved compliance with clinical practice guidelines was seen in both models.
  
  
  CONCLUSIONS
  Further study is required to adequately compare these tele-ICU models with regard to clinical outcomes and financial sustainability. With respect to tele-ICU effects on mortality and length of stay improvements and on-site staff acceptance, existing evidence favors the Centralized Monitoring Model. Studies addressing the Virtual Consultant Model are growing in number and are necessary before proper comparisons can be made.
authors.affiliation: 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center , Stanford, California.
authors.forename: Venktesh R
authors.initials: VR
authors.lastname: Ramnath
authors.forename: Nayer
authors.initials: N
authors.lastname: Khazeni
mesh_terms: D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008991:Monitoring, Physiologic; D011787:Quality of Health Care; D017216:Telemedicine; D016526:Workload
keywords: remote monitoring; remote presence; tele-intensive care unit; teleconsultation; telecritical care; telehealth