Telecritical Care Structure as an Agent of System Change

Sunday, March 22, 2026

9:45 AM - 10:45 AM Central Time

Location: Connections Central - RST 01

Marie Mercier, MSN, APRN, AGCNS-BC, NEA-BC (she/her/hers)

North Carolina

Disclosure(s): No relevant financial relationship(s) to disclose.
SM

Shannon Morris, MSN, APRN, ACCNS-AG, CCRN

RN Administrative Supervisor
Virtual Critical Care, Advocate Health

Disclosure information not submitted.
Carly Boger, BSN, RN, CCRN

North Carolina

Disclosure(s): No relevant financial relationship(s) to disclose.
NH

Noelle Hartley, MSN, RN, CCRN-e, NEA-BC

Clinical Nurse Program Coordinator
Atrium Health Mint Hill Primary Care

Disclosure information not submitted.
Erika L. Setliff, DNP, APRN, CCRN, ACNS-BC, FCCM

Atrium Health, North Carolina

Disclosure information not submitted.
MR

Michael Reif, MD

Intensivist
Virtual Critical Care, Advocate Health

Disclosure information not submitted.
NT

Nehal Thakkar, MD

Intensivist
Atrium Health

Disclosure information not submitted.
CW

Christy Wilbanks, FNP-C, AGACNP-BC

Chief APP – AH Virtual Critical Care
Atrium Health

Disclosure information not submitted.
CR

Chris Russell, MD

Assistant Specialty Medical Director
Atrium Health

Disclosure information not submitted.

Introduction: A large telecritical care unit, known as the Virtual Critical Care Unit (VCC) supports over 200 ICU beds at 17 sites in NC and GA. The VCC is strategically aligned with regional multidisciplinary practice and quality structures, leveraging the scope and expertise of the telecritical care clinicians to identify and resolve practice gaps and system trends across a large critical care network.

Methods: VCC Team observations, safety concerns, and practice opportunities are discussed in huddles and through engaging clinicians in professional governance. The VCC Quality Review Committee (QRC) completes in-depth reviews of any events and practice issues reported. VCC clinicians lead and participate in regional level committees and site- and unit-based councils to bridge practice gaps. Physician, RN, and Advanced Practice Providers from the VCC engage with regional multidisciplinary Care Alignment councils to drive change resulting from findings from VCC. The structure of the team leverages VCC clinicians as agents of change to support frontline clinicians across the region as they adapt to new protocols, orders, and policies.

Results: There were 184 practice issues and 73 system issues reviewed through the QRC in 2024, with 88 and 33 YTD in 2025 respectively. Through collaboration with practice and quality structures, improvements have been made to BiPAP protocols and policy to reduce delays in care. Practice variation in use of restraints and sedation have been reviewed for clarity and consistency. Standardization has improved in electrolyte ordering processes, medication availability at sites, and missing code status orders. EMR changes have been optimized to reduce sedation left on the medication administration record after extubation. Alcohol withdrawal (AWS) practices were improved through engaging VCC RNs in identifying patients requiring ICU AWS orders and through feedback based on VCC observations. Verbiage was added to select medication guidelines to support the role of virtual providers, and standardization of post-cardiac arrest management practices were supported.

Conclusions: The structure of a robust, empowered virtual critical care team can improve care across a large system through structured feedback loops and engaging leaders and skilled clinicians in meaningful process improvement.