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Beyond the Bunker

A Decentralized Model for Tele-Critical Care For the entire history of critical care telemedicine, the practice of tele-ICU has been primarily associated with central command centers. Central command centers, also referred to as bunkers or hubs, link intensivists and other personnel to multiple hospitals so that a relatively small number of critical care physicians can oversee the care of a large number of ICU patients. Capital costs of construction, installation, and training for a new command center range from $6 million to $8 million . At a time when healthcare costs must be minimized, reconsidering the value of central command centers is necessary. In numerous studies , tele-ICU has shown to improve patient outcomes and decrease mortality as well as ICU length of stay. Tele-ICU has clearly shown value in keeping patients closer to home, allowing smaller hospitals to treat high-acuity situations. So the question is, how key is a central command center to an effective tele-ICU progr
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