A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport

Abstract

Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.

Development Status and Prospect of Remote Diagnosis and Treatment of Echocardiography Worldwide

“…Labeling Toll Support senmding voice, text, and local files scholar Christopher A Rouse and other doctors reported the remote diagnosis of echocardiography performed in the asynchronous mode across the Pacific Ocean, which also confirmed the avoidance of long-term and potentially dangerous transshipment of patients across the Pacific Ocean, and greatly reduced the cost [8]. Cloud servicebased triple synchronous dual real-time interactive remote echocardiography consultation between the People's Hospital of Henan Province and the grass-roots hospitals in China in 2019 not only solved difficult cases at the grassroots hospitals, reduced unnecessary transfers of patients, but also provided real-time guidance to the operation methods of primary-level ultrasound doctors, improved the medical technology level of primary-level hospital doctors, and won unanimous praise from primary-level hospital doctors [5].…”

“…With the development of communication technology (Fig. 1), scholars from the United States, Western Europe, and other countries have successfully reported the application of remote echocardiography by using integrated business data network (ISDN) and T1 communication lines [8]. In recent years, remote echocardiography diagnosis and consultation based on Internet and cloud service technology have increased significantly.…”

Transport of the Critically-III Cardiac Patient

“…This can avoid confusion on the part of the referring institution and avoid false conclusions on the part of the transporting institution. The advent of tele-medicine, including tele-echocardiography, may optimize the transport process including reducing unnecessary transport [7].…”

Telemedicine Network in Pediatric Cardiology: The Case of Tuscany Region in Italy

“…This approach was effective to increase efficiency and quality of care, to improve echo examination quality, to prevent unnecessary transport of babies without critical heart disease, to enhance sonographer skill level, to yield financial savings, to decrease length of hospitalization, and to raise patient and physician satisfaction. More and more institutions are implementing tele-echocardiography [2,[10][11][12][13][14][15][16][17][18].…”