While critical illness can strike at any time and demands continuous attention, allocation of scarce staff follows a predictable pattern. The night shift is more likely to have newer inexperienced staff that need more support, but there are less resources onsite. There is also a shortage of intensivists in the United States with the southeastern region being at the top of that list. These factors have led to a greater need for expertise, yet many ICUs do not have onsite physicians on those hard to fill shifts. To mitigate that nighttime thinness, Emory currently supports bedside caregivers with remote guidance from senior intensivists and critical care nurses using an efficient telehealth system, “eICU”. Those senior caregivers in the eICU are challenged to provide outstanding care throughout the night despite the obvious disruption in their normal wake-sleep cycles. Emory Healthcare designed a six-month pilot project aimed at mitigating the sleep–wake cycle disturbances of the night staff working in the Emory eICU Center. What began as a six-month pilot, is now a standard model of remote care for Emory ICU coverage. In this chapter there are points related to the challenges of setting up this program, while also highlighting the advantages. The following areas of focus are: Through the course of setting up this program, we navigated those challenges and that experiential knowledge is throughout the chapter.