Impact of Critical Care Telemedicine Consultations on Children in Rural Emergency Departments*

Dharmar, Madan; Romano, Patrick S.; Kuppermann, Nathan; Nesbitt, Thomas S.; Cole, Stacey L.; Andrada, Emily R.; Vance, Cheryl; Harvey, Danielle; Marcin, James P.

doi:10.1097/ccm.0b013e31828e9824

Cited by 142 publications

(109 citation statements)

References 46 publications

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“…[156][157][158] With telecardiology, pediatric patients can more quickly be evaluated, stabilized, and triaged to determine the need for transport and more advanced treatment or even surgery. 159 Furthermore, telecardiology can be used in all of these settings for case reviews, education, and quality improvement, in conjunction with originating referral sites.…”

Section: Telemedicine In the Intensive Care Settingmentioning

confidence: 99%

“…173,[181][182][183] Although large, randomized trials are lacking, there are increasing acceptance and anecdotal evidence that providing pediatric critical care and telecardiology consultations to remote EDs for children with suspected or known cardiovascular disease is feasible and of clinical utility. 156,158,183 Overall, although more research is needed, it is logical that pediatric telecardiology consultations to rural and underserved EDs through telemedicine can be used to help address disparities in access to specialists and, in doing so, improve the overall quality of care. It is also likely that, because of better care and the reduction in unnecessary transports, telemedicine consultations to rural and underserved EDs can be provided in a cost-efficient manner that reduces the healthcare costs that would otherwise be encountered if telemedicine were not used.…”

Section: Telecardiology In the Edmentioning

confidence: 99%

See 1 more Smart Citation

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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Section: Telemedicine In the Intensive Care Settingmentioning

confidence: 99%

Section: Telecardiology In the Edmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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“…Telemedicine technologies can also increase the overall quality and comprehensiveness of care delivered. 28,29 …”

Section: Quality Of Carementioning

confidence: 99%

The Use of Telemedicine to Address Access and Physician Workforce Shortages

Rimsza¹,

Hotaling²,

Keown³

et al. 2015

Pediatrics

Self Cite

184

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The use of telemedicine technologies by primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (henceforth referred to as “pediatric physicians”) has the potential to transform the practice of pediatrics. The purpose of this policy statement is to describe the expected and potential impact that telemedicine will have on pediatric physicians’ efforts to improve access and physician workforce shortages. The policy statement also describes how the American Academy of Pediatrics can advocate for its members and their patients to best use telemedicine technologies to improve access to care, provide more patient- and family-centered care, increase efficiencies in practice, enhance the quality of care, and address projected shortages in the clinical workforce. As the use of telemedicine increases, it is likely to impact health care access, quality, and education and costs of care. Telemedicine technologies, applied to the medical home and its collaborating providers, have the potential to improve current models of care by increasing communication among clinicians, resulting in more efficient, higher quality, and less expensive care. Such a model can serve as a platform for providing more continuous care, linking primary and specialty care to support management of the needs of complex patients. In addition, telemedicine technologies can be used to efficiently provide pediatric physicians working in remote locations with ongoing medical education, increasing their ability to care for more complex patients in their community, reducing the burdens of travel on patients and families, and supporting the medical home. On the other hand, telemedicine technologies used for episodic care by nonmedical home providers have the potential to disrupt continuity of care and to create redundancy and imprudent use of health care resources. Fragmentation should be avoided, and telemedicine, like all primary and specialty services, should be coordinated through the medical home.

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“…In addition, telemedicine may play a key role in areas where long transport times delay the receipt of definitive specialty care. 60 Such regional systems would also be helpful in preparing for natural or human-caused disasters in which large numbers of children are involved.…”

Section: The Future Of Pediatric Emergency Medicinementioning

confidence: 99%

Emergency Care For Children In The United States

2013

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A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs.

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Impact of Critical Care Telemedicine Consultations on Children in Rural Emergency Departments*

Cited by 142 publications

References 46 publications

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

The Use of Telemedicine to Address Access and Physician Workforce Shortages

Emergency Care For Children In The United States

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