The Impact of Telemedicine on Pediatric Critical Care Triage*

Harvey, Jillian; Yeager, Brooke E.; Cramer, Christina K.; Wheeler, D. M.; McSwain, S. David

doi:10.1097/pcc.0000000000001330

Cited by 41 publications

(42 citation statements)

References 27 publications

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“…3 As early as 1978, pediatric providers have leveraged the use of telehealth to increase access to tertiary care sites and providers 4 both as a means to extend outpatient 5,6 and acute inpatient specialty care. 7,8 Multiple models of telemedicine care have been described in specialties such as pediatric cardiology, 9,10 endocrinology, 11,12 orthopedic surgery, 13 and palliative care 14 among others. Studies on the use of telemedicine in pediatric outpatient care in the United States have revealed potential cost-savings to families, 15 increased health-related quality of life and satisfaction, 16 and less school and work time missed.…”

Section: Introductionmentioning

confidence: 99%

Pediatric subspecialty telemedicine use from the patient and provider perspective

et al. 2021

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Background To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic. Methods We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children’s hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication. Results We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7 ± 19.3%. Conclusions Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care. Impact This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.

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Section: Introductionmentioning

confidence: 99%

Pediatric subspecialty telemedicine use from the patient and provider perspective

et al. 2021

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“…The coordinator is also responsible for liaising with the accepting clinicians, and for organising bed availability at the receiving hospital. Telemedicine has been shown to improve the accuracy of triage during paediatric critical care retrieval and may improve quality of care in rural settings …”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation by a specialised paediatric retrieval team

Glasheen

Holmes

Rampersad

et al. 2019

Emerg Medicine Australasia

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Objectives Intubation of critically ill children is an infrequent procedure, and is associated with significant risk. We set out to describe intubations carried out by the Children's Health Queensland Retrieval Service (CHQRS), with the intention to identify areas for improvement in the performance of intubation in the retrieval setting. Methods Paediatric patients undergoing transport while intubated were identified, and cases where intubation occurred after the arrival of the CHQRS team were examined. Results Over the study period of January 2015 to September 2018, 498 intubated retrievals were undertaken; 85 patients were intubated after the arrival of CHQRS; the age range was 1 day to 16.5 years (median 0.5, interquartile range [IQR] 0.11–3 years). The median weight was 6.2 kg (IQR 3.7–16.5 kg). The pathology requiring intubation included respiratory 36 (42.3%), sepsis 21 (24.7%), neurological 11 (12.9%) and trauma 7 (8.2%). A total of 470 of 498 (94.4%) of intubated patients were from regional referral or tertiary hospitals, 28 of 498 (5.6%) were from rural and remote facilities. Of 85 patients, 57 (67.1%) were intubated by CHQRS and 28 (32.9%) were intubated by a doctor from the referring facility. The CHQRS team was more likely to perform the intubation in smaller children (median weight 5.0 vs 9.9 kg, P = 0.03). The mean scene time was 2.8 h. The scene time was shorter if the intubation was performed by CHQRS (mean 2.6 h, median 2.5, IQR 1.8–3.3; median 3, IQR 2.2–3.9; P = 0.048). The scene time was shorter when the intubation was predicted from tasking information (2.6 vs 3.1 h; P = 0.03). Conclusion Paediatric endotracheal intubation is an infrequent procedure in our service. An airway registry could improve documentation and gather information to identify specific training requirements and areas for practice improvement.

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“…It is relatively simple, more accurate than a telephone consultation, more comfortable for the health care provider at facilities with a lower level of care, and improves processes and reduces costs. [59][60][61][62] In the province of San Luis, Argentina, positive results were reported using this modality. 63…”

Section: Referral Bundlementioning

confidence: 99%

Recommendations for the management of pediatric septic shock in the first hour (part two)

2019

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In 2016, the Surviving Sepsis Campaign and the National Institute for Health and Care Excellence (NICE) developed clinical practice guidelines for the management of pediatric septic shock. In 2017, the American College of Critical Care Medicine (ACCM) updated its recommendations for hemodynamic support of pediatric shock. Recognizing septic shock is critical, as well as an optimal, time-sensitive treatment. An adequate consultation with a pediatric specialist and/or a timely referral to a facility with a higher level of care are also critical for an appropriate outcome in the management of this condition. Here we analyze the bundles used in the management of these patients, which are essential to improve the quality of care.

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The Impact of Telemedicine on Pediatric Critical Care Triage*

Cited by 41 publications

References 27 publications

Pediatric subspecialty telemedicine use from the patient and provider perspective

Pediatric subspecialty telemedicine use from the patient and provider perspective

Endotracheal intubation by a specialised paediatric retrieval team

Recommendations for the management of pediatric septic shock in the first hour (part two)

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