Pediatric trauma telemedicine in a rural state: Lessons learned from a 1-year experience

Taylor, Mark A.; Knochel, Miguel L.; Proctor, Spencer J.; Brockmeyer, Douglas L.; Runyon, Lisa A.; Fenton, Stephen J.; Russell, Katie W.

doi:10.1016/j.jpedsurg.2020.10.020

Cited by 20 publications

(20 citation statements)

References 11 publications

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“…The differences in the urgency assessment were also related to respiratory rate, heart rate or pain, oxygen saturation, the Glasgow coma scale and trauma injuries. This study confirms that trauma cases should be assessed very carefully when employing telemedicine [ 15 , 16 , 30 ]. Undertriage is a serious problem that requires specific attention in a follow-up study.…”

Section: Discussionsupporting

confidence: 78%

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Triage through telemedicine in paediatric emergency care—Results of a concordance study

et al. 2022

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Background In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system. Methods Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen’s kappa, between the two paediatricians. We have also included patient and assessor demographics. Results A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician’s and telemedicine paediatrician’s urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient’s condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen’s weighted kappa was 0.64 (95% CI: 0.49–0.79), indicating a substantial agreement between the specialists. Conclusions Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals’ organisational processes. The processes should include intensive training for the doctors involved in telemedical triage. Trial registration DRKS00013207.

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Section: Discussionsupporting

confidence: 78%

“…Other limitations include the bounded feasibility of urgency assessments and the assessment of the need for on-site treatment for brain injuries or concussions (e.g. for specialised neurological care or intervention) [ 15 , 16 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Triage through telemedicine in paediatric emergency care—Results of a concordance study

et al. 2022

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“…Telehealth benefits include cost savings, bridging geographic gaps in care, increased specialist availability, and decreased trauma transfers from referring hospitals to improve health care utilization. 11 The cost of TH visits vs. IP visits on average was noted to be $89 TH vs. $1116 IP. 22 Associated cost savings, such as decreased travel expenditure, with positive patient satisfaction scores have also been reported.…”

Section: Discussionmentioning

confidence: 96%

“…26 Credentialing for practitioners and legal barriers on an interstate basis exists. 5,11,24,27 Physicians that facilitate TH visits must become credentialed at all remote sites and states where the patient may be residing. State medical licensure requirements are also variable.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric surgical patients benefit from the utilization of TH platforms and the adjuncts of telemedicine. [9][10][11] In response to the TH platform's positive attributes and the ongoing health crisis, there has been a sharp rise in the innovation and implementation of TH platforms. 9,[12][13][14] Utilizing a combination of text messaging and telephone calls to assess surgical patients in the early postoperative period demonstrated TH to be a safe and favorable alternative to IP follow-up visits.…”

Section: Introductionmentioning

confidence: 99%

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Leveraging Collaboration in Pediatric Multidisciplinary Colorectal Care Using a Telehealth Platform

López

Svetanoff

Rosen

et al. 2021

The American Surgeon

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Purpose Pediatric colorectal problems often require complex multidisciplinary care (MDC), which has been affected by the SARS-CoV-2-2019 (COVID-19) pandemic. We describe our utilization and implementation of telehealth (TH) for pediatric colorectal surgery MDC visits and collate patient satisfaction using TH compared to in-person (IP) visits. Methods Implementation of a single-institution MDC TH platform to perform patient visits on February 1, 2020 was studied. Following 6 months of implementation, TH visits’ characteristics were compared with IP visits in the 3 months before implementation by patient volume, length of clinic visits, and patient satisfaction survey results. Results Before implementation, 152 (100%) of clinic visits were IP. During the implementation, 87 (37.7%) were TH visits. Seventy-four (49%) were MDC visits, 17 (23%) of these using the TH platform. Each TH visit’s median length was 25 minutes (IQR 15-30), while the median length of IP visits was 45 minutes (IQR 30-45). Pre-implementation satisfaction scores were 88.6% positive, while satisfaction scores after implementation were 96.8% positive. None of the patients who utilized the TH platform had an unplanned hospital admission within 24 hours of being seen. Conclusion Our experience demonstrates that the TH platform can provide an efficient avenue for established patients and families to receive highly complex multidisciplinary follow-up care. High levels of patient satisfaction indicated that TH should become part of the routine care plan for patients who require long-term or consistent follow-up.

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Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research

Tenforde,

Alexander,

Alexander

et al. 2023

PM&R

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Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in‐person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.

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Pediatric trauma telemedicine in a rural state: Lessons learned from a 1-year experience

Cited by 20 publications

References 11 publications

Triage through telemedicine in paediatric emergency care—Results of a concordance study

Triage through telemedicine in paediatric emergency care—Results of a concordance study

Leveraging Collaboration in Pediatric Multidisciplinary Colorectal Care Using a Telehealth Platform

Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research

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