—Photo-Illustration by TIME (Source Images: Pexels, Arafat Uddin via Canva)It was the middle of the night in the intensive care unit (ICU) of Island Hospital in Anacortes, Wash., and a patient was hallucinating and in withdrawal from alcohol. The Ativan he’d been given wasn’t enough to lower his heart rate, and Joyce Selph, a longtime nurse, was called over to assist.
The protocol, she knew, was to call the attending physician and figure out next steps, but there was a problem. The hospital used a teleICU model, in which doctors staffed the ICU during the day, but only remote doctors were available overnight, via computer screen. Selph and the other nurses had tried to reach the teleICU doctor, but no one answered the calls.
There was no one else to ask, and the patient was rapidly deteriorating. So Selph, who had been a nurse for more than 30 years, did what she assumed a doctor would do; she started the patient on Precedex, a medication that can help sedate a patient.
Giving medication without a doctor’s orders risked her license, Selph knew, but not doing anything risked the patient’s life. The patient survived. Selph was so disturbed by the incident that she complained to her nursing supervisors and to the hospital’s administration that having a doctor on screen rather than in person was bad policy, but they decided to keep it for financial reasons, she says.
Soon after, Selph quit her job at Island Hospital, she says, because she felt that the teleICU was endangering patients’ safety and making her practice outside of her scope.
“They did it as a cost-saving measure because they were having trouble getting hospitalists to want to be there,” Selph says. “But I felt very strongly that it was unsafe.” (Island Health said, in a statement to TIME, that it launched a teleICU program in 2021 to strengthen the level of critical care available in its rural community. It has used a vendor to run the program, the spokeswoman said, and “any technical challenges that have arisen have been addressed directly with [the vendor] to ensure continued safe, effective patient care.”)
More hospitals are implementing teleICUs, especially overnight, as they struggle to recruit enough providers while keeping costs low. Having a remote physician who can staff multiple hospital ICUs at once can keep ICUs open and revenue coming in, even in the midst of an ongoing shortage of doctors. Though the model was initially pitched as a way to help rural systems deploy experts at all hours, it is frequently used in more urban and suburban areas as well. One 2025 paper surveyed 574 adult ICUs across the country and found that about one third implemented some form of telemedicine.
The teleICU model has been gaining attention recently after Conor Hylton, a 26-year-old dental student, died in 2024 after being transferred to an teleICU at the Milford Campus of Bridgeport Hospital in Connecticut, part of Yale New Haven Health. In March 2026, his family filed a lawsuit over his treatment. The complaint included an inspection report from the Centers from Medicare and Medicaid Services (CMS) that found, among other failures, that no physician had overseen Hylton’s care after he was transferred to the ICU, and that the ER physician who had been called up to intubate him did not know the way to the ICU and got lost, delaying Hylton’s treatment by crucial minutes.
William Hylton, Conor’s father, told TIME about the experience of watching his son die as a doctor on a big screen tried to give nurses instructions to adjust his ventilator. He’d brought his son to the emergency room with stomach pain the night before and was told he’d be hydrated inpatient and released shortly after. Conor was transferred to the ICU after William had left for the evening, because his pancreas was inflamed and his heart was racing. The hospital violated its own policy by not informing Conor’s parents that he had been transferred, the CMS report found. His parents got a call at 4:30 a.m. alerting them that their son was near death and in the eICU; they raced to the hospital where they watched their son die, 11 hours after he had arrived at the hospital. “I started thinking about the guy in the screen, and thinking, ‘What the hell was that?’” Hylton says. “Why wasn’t there someone at his bedside?”
The hospital in Connecticut isn’t the only teleICU where patient care appears to have suffered because of the remote setup. TIME reviewed hospital inspection reports from the last six years by the Centers for Medicare and Medicaid Services and found three other instances in which patients died or received substandard care after interacting with a teleICU doctor. In one 2024 instance in Los Banos, Calif., a teleICU physician ordered a medication for a patient whose heart rate was rapidly dropping, “but the record did not indicate it was administered,” the inspection says, and the patient died. In 2021 at a medical center in Reading, Penn., a teleICU physician ordered that a patient with COVID be intubated, but no in-person doctor capable of inserting a chest tube was available for two hours; the patient coded while the chest tube was finally being inserted. And at a hospital in Louisiana, a critically ill patient could not be transferred to another facility for care because hospital staff “failed to follow the appropriate process for after-hours when there was no in-house physician on call.” They did not know they were supposed to call the teleICU doctor, and the patient died while waiting to be transferred.
Experts say that while teleICUs can be useful in providing care, many hospitals don’t use them effectively and instead use them primarily to cut costs. “It can definitely be misused if the goal is to make the spreadsheet look good and staff as many beds as possible with one doctor,” says Dr. Eric Scholten, who works as an teleICU doctor in a system in the American West where he says the system functions well. (His hospital did not give him permission to speak on its behalf.)
Selph says that nurses are often the ones who have to take on the duties of examining a patient and assessing them in person because a teleICU doctor can’t. That seems wrong to her. “These patients are being charged for care, thinking they are getting a physician monitoring their case,” she says. “But in reality they weren’t even assessing the patients themselves; it was the nurse assessing and giving information.”
It’s an open secret among many doctors and nurses that some hospitals with teleICUs provide poor quality care. One doctor whose practice contracts with a teleICU in North Carolina and provides services there—who wished to remain anonymous—told TIME that none of the doctors in his practice send their families to the hospital where the teleICU is used because they all think it’s sub-standard care. “The running joke is, ‘Don’t send me to that hospital if I’m sick,’” he says.
The rise of the teleICU
TeleICUs first became popular in the mid-2000s after research suggested that patients in ICUs would benefit from having what’s called an “intensivist,” an expert in treating ICU patients, available 24-7, says Deena Costa, a professor at the Yale School of Nursing who has studied teleICUs. At the time, many hospitals didn’t have intensivists available overnight.
A company called Visicu, founded in 1998 by two intensivists at Johns Hopkins Hospital, became the leading company to provide this teleICU technology, advertising that it could cut costs by 25% while making an intensivist available around the clock and reducing the number of ICU deaths: a win-win-win.
Costa, who was an ICU nurse before going into academia, says she remembers the buzz around the Visicu system at the time, but that nurses she interviewed had mixed feelings about its effectiveness. Some told her they felt micromanaged and surveilled. Since then, some studies have suggested that the round-the-clock presence of an intensivist isn’t as essential as researchers once thought because it doesn’t have an impact on mortality, she says.
But many hospitals had already embraced the teleICU system, and for some, there was no going back. By 2016, Philips, which had acquired Visicu in 2008, was touting the financial benefits of teleICUs, citing a study that found that they increased case volume by 44% and helped save hospitals tens of millions of dollars by reducing the need for doctors on the premises.
ICUs on their own don’t generally bring in a lot of revenue for hospitals, says Dr. Nandita Nadig, an associate professor at Northwestern University’s Feinberg School of Medicine and a critical care doctor. But some hospitals that have other specialties that may bring in revenue, like a stroke center or a surgeon who performs bypass surgery, are required to have ICUs if they want to have those specialties, she says.
By 2018, about 18% of total ICU beds in the U.S. used telemedicine critical care, up from less than 5% in 2010, one study found.
Then came the pandemic. As ICUs became filled with critically ill people and hospitals faced a shortage of critical care doctors, more facilities adopted the technology.
By October 2020, Philips said it was seeing “increased interest in telehealth solutions like Tele-ICU.”
The benefits of teleICUs
For hospitals, the big benefit of a teleICU is that it can provide the perspective of a critical care doctor without having to pay for one to be at your facility at all hours. This is especially beneficial for rural hospitals that can’t afford to staff a critical care specialist around the clock, or for a larger health system where one virtual specialist can check in on patients at multiple hospitals.
“The reality is that not every place is desirable to raise a family or build a life, so you do need some of this backstop—I do believe there’s a place for it,” says Dr. Allison Harriott, a critical care and emergency medicine physician who has researched teleICUs. “But can it fully supplant what I do at the bedside? I don’t think so.”
Having a remote intensivist available to lend expertise can be useful for patients in rural areas, says Nadig. Intensivists may see a red flag that a patient should be put on a heart-lung machine, for instance, or that they need a lung transplant. They can also help patients who are in small, local hospitals stay in their communities, she says, rather than be transferred hundreds of miles to a facility with an intensivist.
The U.S. has a shortage of intensivists, Nadig says, and as patients get older and their care becomes more complex, teleICU doctors can be better than not having any intensivist available.
One 2025 study funded by Philips found that from 2012 to 2020, hospitals with telecritical care capabilities had lower patient death rates in the ICU and shorter ICU stays. Philips customers use the technology “to extend access to intensivist expertise, support bedside clinicians, monitor patient populations and help identify patients who may need earlier intervention,” says Martijn Hartjes, an executive at Philips who leads hospital patient monitoring.
But both Hartjes and Nadig agree: a teleICU doctor should not replace bedside physicians. “The value of a teleICU is really how well it’s applied,” says Nadig. Hartjes echoed this sentiment. “The Philips eICU program,” he says, “is intended to supplement, not replace, bedside care.”
Problems with implementation
The original purpose of teleICUs seems to have been lost in recent years, Nadig says. A 2021 study found that teleICUs were actually less predominant in rural hospitals than in urban and suburban hospitals.