# Impact of virtual ICU implementation on clinical outcomes across multiple critical care units: A before-and-after study

## TL;DR

A virtual ICU program reduced time in intensive care and use of breathing support and blood-pressure medicines, especially for surgical patients, without affecting overall hospital stays or death rates.

## Contribution

Demonstrates the feasibility and specific clinical benefits of virtual ICU implementation in critical care units.

## Key findings

- ICU length of stay decreased from 232 to 198 hours after vICU implementation.
- Ventilation time and vasopressor use were significantly reduced in the established vICU period.
- The greatest improvements were observed in the surgical ICU, with reduced ICU stay and ventilation time.

## Abstract

Virtual intensive care units (vICUs) provide continuous remote monitoring and support for critically ill patients. Increasing patient complexity and staffing shortages have driven interest in vICUs, but evidence of their impact on clinical outcomes is limited. This study evaluated the effect of vICU implementation across critical care units in a large academic medical center. We conducted a before-and-after study comparing outcomes during the initial vICU implementation period (October 2022–April 2023) and the established program period (October 2023–April 2024), with a 6-month washout interval. Adult patients from a multispecialty surgical intensive care unit (ICU), neurocritical care unit, and ICU step-down unit were included if they had ICU stays longer than 6 h, hospital stays under 30 days, and mechanical ventilation for at least 12 h. The primary outcome was ICU length of stay, with secondary outcomes including hospital stay, ventilation time, vasopressor use, readmissions, and mortality. Among 530 patients (266 implementation, 264 established), ICU length of stay decreased from 232 to 198 h (p=0.011), ventilation time from 110 to 90 h (p=0.044), and vasopressor use for more than 12 h from 55% to 43% (p=0.007). Hospital stay, mortality, and readmission rates were unchanged. Subgroup analysis showed the greatest improvements in the surgical ICU, with reductions in ICU stay, ventilation time, and vasopressor use. These improvements may reflect earlier recognition of deterioration, better care coordination, and timely withdrawal of intensive therapies. Variation across units highlights the need to tailor vICU integration strategies to specific clinical workflows. These findings suggest that vICU implementation is feasible and may enhance critical care efficiency, though further multi-center studies are needed to determine generalizability and to assess patient-centered and economic outcomes.

We investigated whether a virtual intensive care program could improve the care of critically ill patients in a large hospital. This program allows experienced clinicians to monitor patients remotely and to provide guidance to the primary clinical care team. We compared results from when the program first started to when it was fully in place. In the later period, patients spent less time in the intensive care unit, needed breathing support for fewer days, and needed blood-pressure–supporting medicines for a shorter time. These benefits were especially evident in patients recovering from surgery. Importantly, overall hospital stay, death rates, and readmissions remained similar, suggesting the improvements were specific to critical care management. Our findings indicate that virtual intensive care may help identify patient issues earlier, improve coordination of care, and reduce prolonged intensive treatments. This work lays the foundation for future studies examining how virtual care can enhance patient recovery and hospital efficiency.