Teleneurocritical Care (TeleNCC) Consensus Statement

BACKGROUND AND PURPOSE: Teleneurocritical care (TeleNCC) provides virtual neurocritical care in emergency departments and intensive care units that do not have continuous in-person coverage. However, there is limited evidence upon which to apply standards, benchmarks, and best practice. The scope of TeleNCC practice is beyond that of Telestroke and Telecritical Care, both of which have existing guidelines. Here, an international authorship group was convened to prepare a consensus statement on both the minimal requirements and optimal conditions for effective adult and pediatric TeleNCC. METHODS: A panel consisting of 22 multidisciplinary experts in TeleNCC reviewed the available published literature, held ten virtual meetings between April 2023 and June 2024, used a modified Delphi consensus method, and voted on recommendations for best practices of TeleNCC. In two phases, a total of 13 sections on specific components of TeleNCC were written, reviewed, revised, and finalized following authorship group consensus. Specific expert rationale and applicable supportive evidence, when available, were included and integrated into each section following the recommendation(s). RESULTS: Authorship consensus was achieved. For any disagreement exceeding 15%, there was additional group discussion and addition of explanatory text. Recommendations encompassed the following 13 sections, grouped by structure, operations, and quality; TeleNCC sections: (1) models, (2) organization in health system, (3) structural elements, (4) staffing and engagement, (5) clinical roles and responsibilities, (6) activation and communication, (7) afterhours and anticipatory guidance, (8) regulatory and credentialing, (9) finance, (10) pharmacy, (11) quality, (12) outcomes, and (13) the research gaps, training, and education. We recommend that TeleNCC: be available 24/7, though it may be utilized on a part time basis, use a reliable two-way audio-visual telecommunication system with backup options, allow for the hub TeleNCC provider to have real-time access to patient data contained in an electronic health record, as well as the original, nonprocessed raw electroencephalogram and direct diagnostic radiological imaging data. We suggest that phone-only interactions do not meet the minimum requirements for TeleNCC. The health care system should have defined roles and responsibilities for TeleNCC at the hub and spoke sites, including: a spoke site in-person provider(s) one of which is able to perform critical care procedures, clearly defined daytime and afterhours communication protocols, and have streamlined credentialing and financial arrangements. We recommend that regular continuous measurement of quality and outcome tracking is an essential component of TeleNCC practice. We review additional optimal components in well-resourced centers including the integration of advanced digital technology. CONCLUSION: TeleNCC may be an effective method to deliver neurocritical care in acute care environments lacking applicable in-person expertise provided the minimum requirements for standard practice and operations are met.