Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation

Yang, Chris; Hunt, Elizabeth A.; Shilkofski, Nicole; Dudas, Robert A.; Egbuta, Chinyere; Schwartz, Jamie Mc Elrath

doi:10.1097/pec.0000000000000653

Cited by 17 publications

(15 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although limited in number, 86% of these demonstrated improvements in healthcare quality and safety, providing a positive "proof of concept" that pediatric care in community hospitals can be improved by multidisciplinary efforts and be sustained over time. [43][44][45][46][47]49,[51][52][53][54][55][56] As pediatric depart- ments within community hospitals may have limited resources, aligning pediatric QI efforts with adult initiatives within the same hospitals could prove advantageous. However, we did not identify any studies meeting our inclusion criteria that took this approach.…”

Section: Discussionmentioning

confidence: 99%

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Leary

Walsh

Morin

et al. 2019

Journal of Hospital Medicine

View full text Add to dashboard Cite

D espite efforts to provide high-quality healthcare, Americans die from medical errors each year and many patients do not receive recommended medical care. Risk is particularly acute during times of hospitalization. [1][2][3][4] In response, the Institute of Medicine (IOM, now the Academy of Medicine) has released "Crossing the Quality Chasm: A New Health System for the 21 st Century," providing a framework to guide delivery and measurement of high-quality healthcare. 5 Although the IOM framework has motivated the development of quality improvement (QI) and quality measurement initiatives, relatively few resources have been allocated to im-proving the quality of pediatric inpatient care. 6,7 The resultant gap in our knowledge of quality and safety of pediatric hospital-based care is further widened by the variability of settings in which children are hospitalized. These settings include freestanding children's hospitals, children's hospitals nested within larger hospitals, and community hospitals, defined as general, nonuniversity, and nonchildren's hospitals. 8 Although almost three-quarters of children needing hospitalization are cared for outside of freestanding children's hospitals, we know particularly little about the quality and safety of pediatric hospital-based care outside of these settings. 6,9 Therefore, our scoping review aims to summarize literature regarding the quality and safety of pediatric inpatient care within community hospitals. METHODSWe used a scoping review approach because this methodology, by design, is utilized to synthesize evidence and map existing literature and is particularly useful when a body of literature is heterogeneous, rendering a more targeted systematic re-

show abstract

Section: Discussionmentioning

confidence: 99%

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Leary

Walsh

Morin

et al. 2019

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…Observational studies have suggested improved quality of care in the ED or ICU for critically ill or injured children at rural hospitals lacking paediatric subspecialty care with the use of telemedicine consultations 24 25. Other studies have evaluated adherence to clinical resuscitation guidelines, as well as the use in paediatric critical results with varying results in clinical outcomes, but overall positive acceptability 23–29…”

Section: Discussionmentioning

confidence: 99%

Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial

et al. 2018

View full text Add to dashboard Cite

BackgroundThe delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes.IntroductionTelemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access.Materials and methodsProspective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants’ completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist.ResultsTwelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001).ConclusionsIn this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.

show abstract

“…Telemedicine has been defined as “technology‐enabled health and care management and delivery systems that extend capacity and access.” More recently, the benefits of telemedicine have been recognized by the healthcare community and have been increasingly used to enhance the accessibility of tertiary care for children, particularly in rural and underserved areas . In the adult arena, telemedicine has been shown to be effective for the management of multiple cancer‐related symptoms, including pain .…”

Section: The Challenge: Optimizing Cancer Pain Management For Childrementioning

confidence: 99%

“…64 More recently, the benefits of telemedicine have been recognized by the healthcare community and have been increasingly used to enhance the accessibility of tertiary care for children, particularly in rural and underserved areas. 65,66 In the adult arena, telemedicine has been shown to be effective for the management of multiple cancer-related symptoms, including pain. 67 In pediatric oncology, telemedicine has been utilized to improve access to care and has been effective in improving cancer-related outcomes.…”

Section: Telemedicinementioning

confidence: 99%

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Fortier

Yang

Phan

et al. 2019

Pediatric Blood & Cancer

View full text Add to dashboard Cite

The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first‐line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.

show abstract

Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation

Cited by 17 publications

References 20 publications

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review

Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Contact Info

Product

Resources

About