Best Practices in Telecritical Care: Expert Consensus Recommendations From the Telecritical Care Collaborative Network.

Objectives: Telecritical care (TCC) refers to the delivery of critical care using telehealth technologies. Despite increasing utilization, significant practice variation exists and literature regarding efficacy remains sparse. The Telecritical Care Collaborative Network sought to provide expert, consensus-based best practice recommendations for the design and delivery of TCC.
Design: We used a modified Delphi methodology. Following literature review, an oversight panel identified core domains and developed declarative statements for review by an expert voting panel. During three voting rounds, voters agreed or disagreed with statements and provided open-ended feedback, which the oversight panel used to revise statements. Statements met criteria for consensus when accepted by greater than or equal to 85% of voters.
Setting/subjects: The oversight panel included 18 multidisciplinary members of the TCC Collaborative Network, and the voting panel included 32 invited experts in TCC, emphasizing diversity of discipline, care delivery models, and geography.
Interventions: None.
Measurements and Main Results: We identified ten core domains: definitions/terminology; care delivery models; staffing and coverage models; technological considerations; ergonomics and workplace safety; licensing, credentialing, and certification; trust and relationship building; quality, safety, and efficiency, research agenda; and advocacy, leading to 79 practice statements. Of 79 original statements, 67 were accepted in round 1. After revision, nine were accepted in round 2 and two in round 3 (two statements were merged). In total, 78 practice statements achieved expert consensus.
Conclusions: These expert consensus recommendations cover a broad range of topics relevant to delivery of TCC. Experts agreed that TCC is most effective when delivered by care teams with specific expertise and by programs with explicit protocols focusing on effective communication, technical reliability, and real-time availability. Interventions should be tailored to local conditions. Although further research is needed to guide future best practice statements, these results provide valuable and actionable recommendations for the delivery of high-quality TCC.
Competing Interests: Dr. Singh received funding from Intuitive Surgical. Dr. Laudanski’s institution received funding from the National Institutes of Health. Dr. Rincon received funding from Blue Cirrus Consulting, Baxter Healthcare, Phillips Health, and Viven Health. Dr. Villanueva received funding from Intercept Telemed, Banner Health, Pasadena Law Center; he disclosed that he is the Chief Medical Officer of Intercept Telemed, a telecritical care medicine physician for Banner Health; and he owns stock in Omnicure and Fruit Street Health, Public Benefit Corporation, and owns stock in Google, Amazon, Apple, Edwards Lifesciences, Eli Lilly, Johnson and Johnson, Microsoft, Oracle, Palantir, UnitedHealth Group, Berkshire Hathaway, Proctor and Gamble, and Walmart. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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