Telemedicine REsuscitation and Arrest Trial (TREAT): A feasibility study of real-time provider-to-provider telemedicine for the care of critically ill patients

Abstract

BackgroundProtocol-based resuscitation strategies in the Emergency Department (ED) improve survival for out-of-hospital cardiac arrest (OHCA) and severe sepsis but implementation has been inconsistent.ObjectiveTo determine the feasibility of a real-time provider-to-provider telemedical intervention for the treatment of OHCA and severe sepsis.Materials and methodsA three-center pilot study utilizing a “hub-spoke model” with an academic medical center acting both as the hub for teleconsultation as well as a spoke hospital enrolling patients. Eligible patients were adults presenting with either return of spontaneous circulation (ROSC) following OHCA or with severe sepsis. Telemedical encounters were monitored for quality of interface and patient level data (demographics, physiologic, laboratory, treatment) were abstracted.ResultsOver a 12-week period, there were 80 text alerts. Of 38 OHCA alerts, 13 achieved ROSC (34.2%), 85% underwent teleconsultation (11/13). Of 42 “lactate ≥4 mmol/L” alerts, 33.3% (14/42) were determined to have severe sepsis and underwent teleconsultation. Mean time from OHCA teleconsultation request to live connection: 3.7 min (95% CI 1.6–5.8); mean call duration: 71.7 min (95% CI 34.6–108.8). Mean time from sepsis teleconsultation request to connection: 8.4 min (95% CI 4.5–12.3); mean call duration: 61.5 min (95% CI 37.2–85.8).DiscussionTelemedicine provides a robust and reliable means of quickly bringing expertise virtually to the bedside at the most proximal point in a patient’s hospital care.ConclusionsReal time ED-based telemedical consultation for patients with ROSC after OHCA or severe sepsis has the potential to improve the dissemination and implementation of evidence-based care.

Strategies to improve communication in telementoring in acute care coordination: a scoping review

“…Of the 56 articles, 41 focused on improving dispatcher-directed CPR, 6 focused on physician-physician consultation, [56][57][58][59][60][61] and 9 examined telementoring in trauma resuscitation. 8,[10][11][12][62][63][64][65][66] Dispatcher-directed cardiopulmonary resuscitation…”

“…The articles examining trauma resuscitation 8,[10][11][12][62][63][64][65][66] included case series, RCTs and observational studies. Advanced surgical procedures, including laparoscopic surgery, were conducted successfully with the use of a common language between mentor and on-site mentee.…”

Use of Telemedicine to Improve Neonatal Resuscitation

“…In this case, a remote critical care expert can connect via a video-conferencing method to be “virtually present” to provide direct assistance to the healthcare provider team at a remote site. This has been shown to be feasible in the adult [42,43,44], pediatric [45,46,47] and neonatal [48] populations.…”

Comparison of Two Telemedicine Delivery Modes for Neonatal Resuscitation Support: A Simulation-Based Randomized Trial

“…Telemedicine is a common tool that is increasingly playing a significant role in healthcare delivery [1][2][3][4][5]. It represents a promising solution to bring specialist care to patients and providers in resource-limited areas where DOI: 10.1159/000504853 specialists are not available [6].…”

“…It represents a promising solution to bring specialist care to patients and providers in resource-limited areas where DOI: 10.1159/000504853 specialists are not available [6]. A remote specialist can directly provide care to a patient (provider-to-patient telemedicine) [7,8] or support care teams in providing optimal care to their patients (provider-to-provider telemedicine) [1,4]. Both applications of telemedicine have great potential for improving patient outcomes and survival.…”