Implementation and Impact of Tele‐Intensive Care Unit (Tele‐ ICU ) Models on Critical Care Outcomes: A Systematic Review

ABSTRACT Background Tele‐Intensive Care Unit (Tele‐ICU) models have expanded rapidly in response to global critical care workforce shortages, rising patient acuity and the demands of the COVID‐19 pandemic. Contemporary evidence shows substantial variation in Tele‐ICU configurations and outcomes, underscoring the need for an updated synthesis that evaluates clinical, staff‐related and system‐level effects across diverse settings. Aim To examine the implementation and impact of Tele‐ICU models on critical care outcomes and to compare results across hub‐and‐spoke, hybrid, consultative and tele‐recovery configurations. Study Design A systematic review was conducted and reported according to PRISMA 2020 and Joanna Briggs Institute guidelines. PubMed, CINAHL, Scopus, Web of Science and Google Scholar were searched for peer‐reviewed studies published between January 2020 and October 2025. Owing to heterogeneity in Tele‐ICU models, outcomes and effect measures, a narrative synthesis was performed. Results Sixteen studies published between 2020 and 2025 were included, comprising quantitative, qualitative and mixed‐methods designs conducted across high‐, middle‐ and low‐resource healthcare settings. Overall, Tele‐ICU implementation was associated with reductions in ICU and hospital mortality, improved adherence to evidence‐based clinical protocols, enhanced interprofessional communication and reduced clinician documentation burden. Hub‐and‐spoke and hybrid Tele‐ICU models demonstrated the most consistent clinical and workforce benefits, whereas consultative and low‐cost models primarily improved access to specialist care in resource‐limited contexts. Across studies, nursing roles expanded to include digital patient surveillance, tele‐round coordination, protocol facilitation and virtual family communication. Evidence regarding long‐term sustainability and cost‐effectiveness was limited and inconsistently reported. Conclusions Tele‐ICU models enhance clinical performance, support nursing practice and improve system‐level responsiveness across diverse contexts. While benefits are consistent, outcomes vary by model design, local infrastructure and implementation readiness. Longitudinal and economic evaluations are needed to inform sustainable, scalable Tele‐ICU strategies. Relevance to Clinical Practice Tele‐ICU models support bedside nurses by improving access to specialist input, strengthening adherence to evidence‐based care and enhancing patient safety. Evidence shows that Tele‐ICU reduces workload, improves communication and enables nurses to coordinate digital monitoring and family updates, contributing to more consistent and equitable critical care delivery, particularly in high‐acuity and resource‐limited settings.