In 2018 as part of a Tele-ICU redesign, ChristianaCare analyzed and reevaluated their program to align with Quadruple Aim goals. ChristianaCare surveyed their provider team including nursing, APCs and unit staff that work primarily during evening hours. The survey identified issues of burnout, communication, and processes. The nighttime staff felt isolated and unsupported. To address caregiver resiliency concerns as well as improve the relationship between two separate health systems, ChristianaCare initiated a collaborative effort to be more inclusive and ensure that their concerns were heard. The solution was a new nighttime telemedicine program that could eventually be rolled out system wide.