Evaluation of the Clinical Impact of Different Telemedicine Practices in Intensive Care Units: a Stepped-wedge Cluster Randomized Clinical Trial

Inclusion Criteria

Inclusion Criteria for Intensive care units: * Intensive care units from public or philanthropic hospitals. * ICUs with a minimum of 7 and a maximum of 20 beds. * Intensive care units with physician and nurses available 24 hours a day and physiotherapist available at least ≥ 18 hours a day. Exclusion Criteria for Intensive care units: * Intensive care units with structured multidisciplinary round more than three times a week conducted by an intensive care physician (certified), documented in the medical record, with a fixed duration (\>5 min / patient), using some supporting tool (checklist or standard form), goal oriented, based on established protocols, including all the patients admitted to the ICU. * Intensive care units already doing audit and feedback with specific planning. * Dedicated coronary care units/cardiac intensive care units or other specialized units (cardiac surgery, neurological, burned patients). * Step-down units or semi-intensive cardiac care unit. * Intensive care units without availability of substitute renal therapy. * ICU coordinator specialist in intensive care medicine and management training (MBA in Health Management or equivalent). Inclusion Criteria for patients: * Adult patients (≥ 18 years old). Exclusion Criteria for patients: * Admission for other reasons than medical (e.g., judicial cause, legal reasons, safety reasons). * Previously included in the TELESCOPE II trial (for the primary outcome analysis).