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

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.