Background

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Rural Health (ORH) has supported the National TeleCritical Care (NTCC) Enterprise-Wide Initiative (EWI) since Fiscal Year (FY) 2017. The NTCC Program provides virtual bedside care from a physician and critical care nurse 24 hours a day, 7 days a week, 365 days a year.

NTCC practitioners use dedicated telehealth devices at the intensive care unit (ICU) bedside. These devices provide real-time information such as vital signs so NTCC teams can help care for critically ill ICU patients in close collaboration with bedside staff. The program offers co-management, consultation, continuous monitoring, and educational support to affiliated VHA facilities.

NTCC providers are authorized to care for patients in all VHA facilities. They are specially trained in critical care and often hold additional certifications in internal medicine, pulmonary medicine, nephrology, surgery, emergency medicine, and/or anesthesia. NTCC nurses have at least five years of bedside critical care experience, and many hold Critical Care Registered Nurse (CCRN) certification.

Goals and Objectives

The NTCC EWI works to ensure that acutely ill Veterans receive consistent, timely access to advanced intensive care whenever and wherever critical care services are needed. The program strives to be a patient-centered, multidisciplinary team that combines technology and state-of-the-art critical care with a compassionate, caring approach. NTCC aims to work seamlessly with Veterans’ direct care clinical staff to support the highest quality critical care, research, and education.

The program’s goals and objectives help guide NTCC efforts and resources:

• Provide maximum access to critical care management by expanding TeleCritical Care services.
• Develop standardized data, administrative, clinical, and technical processes to support program growth.
• Build and strengthen relationships with stakeholders, and expand outreach to connect with new partners.
• Collaborate with other VHA telehealth programs.
• Ensure a stable technology infrastructure that supports program growth, interoperability, and innovation.
• Promote a culture where staff are valued and empowered by:
  • Implementing High Reliability Organization (HRO) and Just Culture principles.
  • Offering and supporting opportunities for staff development.
  • Encouraging two-way (bidirectional) communication.
  • Building trust and accountability.

Methodology

The NTCC Program is a unified national program that uses standardized systems to deliver TeleCritical Care services. In FY 2024, NTCC operated at 83 active VHA sites (covering 1,306 ICU beds) and one Department of Defense (DoD) medical treatment facility. The program plans to expand to 89 sites and monitor 1,448 ICU beds. Affiliated ICUs include medical, surgical, cardiothoracic/vascular, and stepdown units.

NTCC providers and nurses have access to the same patient information as bedside clinicians, including up-to-the-minute vital signs and monitoring data. This allows the telecritical care team to participate fully in care decisions and patient management.

Active NTCC involvement has been associated with better patient safety and outcomes. Participation in the program has demonstrated substantial cost savings by reducing the number of patient transfers, decreasing ICU length of stay, and improving mortality rates.

Another important benefit is that NTCC helps prevent Veterans from being transferred out of VHA medical centers when local provider coverage is limited. Around-the-clock NTCC support helps maintain safe and continuous intensive care within VA facilities.

Impact on Rural Veteran Health

The NTCC Program is organized as a connected network of hubs staffed by NTCC physicians, nurses, and support personnel. Facilities linked to NTCC range from rural VHA medical centers without medical school affiliations to large, urban, highly affiliated hospitals.

Rural Veterans often live far from advanced medical centers. NTCC helps close this gap by enabling faster clinical decision-making, since remote specialists can assess and help treat Veterans through real-time telehealth technology. NTCC also fills coverage gaps when on-site critical care staff are not immediately available at the time a Veteran is admitted to the ICU.

Key Takeaways

• Veterans whose care includes the National TeleCritical Care Program receive continuous monitoring through advanced audio-visual technology.
• By working closely with bedside teams, NTCC supports lifesaving care. Facilities that use NTCC have seen:
  • Reduced length of stay in the ICU (by about 3%) and in the hospital overall (by about 4.5%).
  • Lower ICU mortality (by about 15%–27%) and lower hospital mortality (by about 16%–28%) compared with VA facilities that do not use NTCC.
  • Even greater reductions in mortality over time in facilities with longer NTCC partnerships (about 21%–25% in the ICU and 25%–30% in the hospital).
• NTCC teamwork and vigilance provide timely, effective patient care. For example, during camera rounds, an NTCC nurse noticed that a Veteran using a BiPAP machine had removed the mask and pulse oximeter and appeared bluish. The NTCC nurse quickly alerted the bedside charge nurse, who repositioned the mask and oximeter and monitored the Veteran’s oxygen levels until they safely returned to normal.
• NTCC cameras offer detailed remote coverage and can detect small but important changes in the room. In one case, an NTCC nurse saw blood near a Veteran’s bed and notified the bedside nurse, who found that a line port was not locked properly and was leaking. The issue was fixed before the Veteran lost too much blood.
• NTCC provides an extra layer of monitoring to ensure that care plans are fully carried out. In another case, NTCC staff noticed a Veteran’s heart rate dropping and suspected untreated sleep apnea. On review, they found that an order for CPAP therapy had not yet been implemented. After the CPAP was applied as ordered, the Veteran’s condition improved.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• Internal National TeleCritical Care Program reports and outcome summaries, Veterans Health Administration, Office of Rural Health (2025).

Contact

• Program Contact: Ralph Panos, MD, Executive Physician Director, National TeleCritical Care Program, VA Cincinnati Healthcare System, Cincinnati, OH. Ralph.Panos@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #RFY-00540.
• Suggested Citation: Panos, Ralph. (2025). National TeleCritical Care Program. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp