Pediatric critical care telemedicine in rural underserved emergency departments*

Heath, Barry; Salerno, Richard; Hopkins, Amelia; Hertzig, Jeremy S.; Caputo, Michael

doi:10.1097/pcc.0b013e3181a63eac

Cited by 134 publications

(105 citation statements)

References 25 publications

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“…Staff acceptance was the primary focus of 10 studies, 23,26,29,30,34,[36][37][38]40,41 whereas it was a secondary focus of the remaining 13. 5,21,22,24,25,27,28,[31][32][33]35,39,42 Tele-ICU Confi guration: There was signifi cant variation in how tele-ICU was defi ned, used, and structured ( Table 2 ). In 12 studies (52%), tele-ICU involved bedside monitors and cameras, 5,24,[29][30][31][32]34,[36][37][38]40,41 whereas the remaining 11 (48%) used mobile cameras or robots.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…In 12 studies (52%), tele-ICU involved bedside monitors and cameras, 5,24,[29][30][31][32]34,[36][37][38]40,41 whereas the remaining 11 (48%) used mobile cameras or robots. [21][22][23][25][26][27][28]33,35,39,42 Likewise, 12 (52%) studies described systems using around-the-clock telemonitoring, 5,21,24,29,30,32,34,[36][37][38]40,41 whereas seven (30%) entailed only on-call consultation, 22,23,31,33,35,39,42 and four (17%) used a system of regularly scheduled telerounds. [25][26][27][28] Thirteen (57%) studies included tele-ICUs structured on a hub-and-spoke model, 5,21,…”

Section: Description Of Studiesmentioning

confidence: 99%

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Staff Acceptance of Tele-ICU Coverage

Young

Chan

Cram

2011

Chest

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A lthough intensivist care is associated with lower ICU and hospital mortality and with reduced length of stay, 1 only one-third of critically ill patients receive intensivist care, and the shortfall is projected to worsen. 2 As a result, hospitals increasingly rely on tele-ICU coverage. 3 For the purposes of this article, we defi ne tele-ICU coverage as the application of telemedicine 4 to in-hospital critical care units, thereby encompassing an array of technologies of varying complexity 5,6 that allow physical ICUs to access critical care experts in real time.At the present time, it is estimated that 10% of US hospitals use some form of tele-ICU coverage, Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU confi guration, methodology, participants, and fi ndings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by . 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required.

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Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Staff Acceptance of Tele-ICU Coverage

Young

Chan

Cram

2011

Chest

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“…Lastly, this study is consistent with previous research which has demonstrated that specialty telemedicine consultations can result in improved patient safety. 18,[39][40][41][42][43][44] …”

Section: Discussionmentioning

confidence: 99%

“…3,8,11 Telemedicine is increasingly used to address some of these shortcomings by providing pediatric specialty consultations to children presenting to rural and underserved EDs as an alternative to telephone consultations. [17][18][19] Specifically, telemedicine has the potential to prevent medication errors resulting from the lack of access to experienced staff and pediatric specialty expertise. [20][21][22][23][24][25] The goal of the current study was to evaluate whether pediatric telemedicine consultations are associated with fewer physicianrelated medication errors among seriously ill and injured children presenting to rural EDs.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors. WHAT THIS STUDY ADDS:The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. abstract OBJECTIVE: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). METHODS:We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children' s hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. RESULTS:Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs 10.8% and 12.5%, respectively; P , .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P , .05) or no consultations (odds ratio: 0.13, P , .05).CONCLUSIONS: Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.

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“…4 At last count, an estimated 10% of ICU beds in the United States were covered by ICU telemedicine in the form of continuous remote monitoring, with many more using some other type of remote care. 7 Pediatric-specific uses for telemedicine in the ICU are also vast and include (1) urgent telemedicine consultations with pediatric intensivists, neonatologists, and cardiac intensivists for children in underserved rural emergency departments or ICUs lacking such expertise [8][9][10][11][12] ; (2) teleconsultations with pediatric subspecialists in infectious diseases, cardiology, and neurology for children in community hospitals without local access to these subspecialists 13 ; and (3) nighttime telecommunication between attending pediatric intensivists on home-call with fellows and residents caring for pediatric ICU patients in a teaching hospital to enhance continuity of care and augment team communication during off hours. 14 Although a wide body of research exists to explore how best to utilize telemedicine to extend the reach of a limited cadre of critical care subspecialty physicians, 15 little has been done to investigate how this technology can be used by non-physician specialists, including respiratory therapists (RTs), for whom the scope of practice is rapidly increasing.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study

Bell

Yager²,

Clark³

et al. 2015

Respir Care

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BACKGROUND: Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. METHODS: We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations. RESULTS: Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and F IO 2 perfectly correlated (r ‫؍‬ 1, all P < .001) as did the presence of a CO 2 monitor and need for increased ventilatory support (kappa ‫؍‬ 1). The Pearson correlation coefficient for V T , minute ventilation, mean airway pressure, and oxygen saturation ranged from 0.84 to 0.97 (all P < .001). kappa ‫؍‬ 0.41 (95% CI 0.02-0.80) for patient-triggered breaths, and kappa ‫؍‬ 0.57 (95% CI 0.19 -0.94) for breathing frequency higher than set frequency. kappa ‫؍‬ ؊0.25 (95% CI ؊0.46 to ؊0.04) for need for suctioning. CONCLUSIONS: Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patientgenerated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope.

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Pediatric critical care telemedicine in rural underserved emergency departments*

Cited by 134 publications

References 25 publications

Staff Acceptance of Tele-ICU Coverage

Staff Acceptance of Tele-ICU Coverage

Telemedicine Consultations and Medication Errors in Rural Emergency Departments

Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study

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