Structured Telecritical Care Feedback as a Mechanism for Resuscitation Quality Improvement

Introduction: The Virtual Critical Care (VCC) is a Telecritical Care unit in the Southeastern U.S. that provides services to over 200 beds in 15 ICUs. VCC provides essential expertise and support to meet the needs of ICU Patients in units without 24/7 intensivist coverage, including resuscitation events ("Code Blue"). Resuscitation support can include VCC provider management of the code via camera, and/or VCC RN involvement to support ACLS protocols as needed, provide feedback on CPR quality and effectiveness, and remaining on camera to assist with EMR access and post-event debriefing. This NHSR quality improvement project (IRB00115222) aimed to improve resuscitation quality through a structured feedback process.


Methods: A post-code debriefing tool was created in RedCAP to evaluate resuscitation quality. Teammates were asked to complete the tool after providing telecritical care support during resuscitation events. Results were monitored on an ongoing basis to evaluate trends, inform areas of opportunity, and to drive improvements in resuscitation at the site, VCC, and healthcare system level.


Results: Twenty-six resuscitation debriefs were completed between July 1, 2024 & June 30, 2025 in 10 of the ICUs covered by the VCC. The most commonly reported issue was communication (61.5%), specifically between bedside and the VCC Team (42.3%), from too many people in the room (19.2%), lack of identified team lead (19.2%), or lack of closed loop communication (19.2%). Issues with VCC Equipment were reported 38.5% of the time with comments about either VCC or bedside teams having difficult hearing. Quality of CPR was identified as an opportunity (34.6%), with real time feedback given and trends shared with site leadership. Airway/Ventilation issues (19.2%) were reported for delayed ventilation, CPR Pauses >10 seconds for airway insertion, and multiple intubation attempts. Least commonly reported concerns were issues with medication knowledge and availability, vascular access, unit equipment, or team activation, each at 11.5%.


Conclusions: Communication is a commonly reported challenge when managing codes through telecritical care, requiring targeted interventions. VCC RNs support a wide range of ICUs, giving them unique perspective and valuable insight into resuscitation practices across the healthcare system.