Pediatric Critical Care Telemedicine Program: A Single Institution Review

Hernández, María de Lourdes García; Hojman, Nayla M.; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S.; Litman, Rebecca; Marcin, James P.

doi:10.1089/tmj.2015.0043

Cited by 28 publications

(19 citation statements)

References 17 publications

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“…Some authors have cited criticisms of community emergency care to advocate more strongly for routine emergency pediatric telemedicine usage . While this may be very appropriate to improve care for the critically ill and for certain other conditions, our findings suggest that simpler, less costly alternatives may effectively address some overtransfers without unnecessary consultation or supervision. While sufficient, real‐time video telemedicine may not be necessary to accurately risk stratify seizure, fracture, or traumatic brain injury patients, while it may improve transfer performance for children with respiratory infections or wheezing.…”

Section: Discussionmentioning

confidence: 70%

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study

Mohr

Harland

Shane

et al. 2016

Academic Emergency Medicine

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Objectives: Interhospital transfer is a common strategy to provide high-quality regionalized care in rural emergency departments (EDs), but several reports have highlighted problems with selection of children for transfer. The purpose of this study is to characterize the burden of potentially avoidable transfer (PAT) and to estimate the medical and family-oriented costs associated with PAT.Methods: This study was a cohort study of all children treated in Iowa EDs between 2004 and 2013. PAT was defined as a child who was transferred and then either discharged from the receiving ED or admitted for ≤ 1 day, without having any separately billed procedures performed. Costs of care were estimated from 1) medical costs, 2) ambulance transfer, and 3) family costs (travel and lodging).Results: Over 10 years, 2,117,317 children were included (1% transferred to another hospital). Only 63% were transferred to a designated children's hospital, and PATs were identified in 39% of all transfers. PAT was associated with $909 in additional cost. The conditions most strongly associated with PAT were seizure (additional cost $1,138), fracture ($814), isolated traumatic brain injury without extra-axial bleeding ($1,455), respiratory infection ($556), and wheezing ($804). Few of these charges are attributable to nonmedical family costs ($21).Conclusions: Potentially avoidable pediatric interhospital transfer is common and is responsible for significant healthcare-related costs. Future work should focus on improving selection of children who benefit from interhospital transfer for high-yield conditions, to reduce the costly and distressing burden that PAT places on rural patients and their families.ACADEMIC EMERGENCY MEDICINE 2016;23:885-894 © 2016 by the Society for Academic Emergency Medicine A ccess to pediatric emergency care is limited in rural America. 1,2 Rural emergency departments (EDs) often are not staffed by residency-trained emergency physicians, and very few have dedicated pediatric emergency medicine providers. 3,4 Many specialists restrict their practice to adult patients. 5 As a result, many pediatric ED patients are transferred to tertiary centers for evaluation and management. In a single-center study, children who were transferred from a facility with a nonpediatric provider were significantly more likely to be discharged from the pediatric ED without any further testing or treatment and much less likely to be admitted. 6 A review of data from the Pediatric Health Information System showed that approximately 40% of children transferred to tertiary care pediatric hospitals were directly discharged after transfer or hospitalized for less than 24 hours, defining a group of potentially avoidable transfers. 7 Potentially avoidable transfers can represent a risky and costly practice that does not improve pediatric

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Section: Discussionmentioning

confidence: 70%

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study

Mohr

Harland

Shane

et al. 2016

Academic Emergency Medicine

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“…Second, the sample size for our subcohort analysis comparing illness severity in pretelemedicine and posttelemedicine cohorts is small, which might limit the detection of a true effect of telemedicine in this context. However, given our relatively short study period and the low volume of critically ill children needing transfer at referring EDs (27), this analysis still provides useful insight into the clinical impact of telemedicine consultations with PICU-based pediatric subspecialists. Third, our study does not address the possibility that the lower illness severity of children transferred from EDs with telemedicine capabilities may simply be a consequence of transferring children who are less sick.…”

Section: Discussionmentioning

confidence: 99%

“…The Pediatric Critical Care Telemedicine Program at the UC Davis Children's Hospital was initiated in 2000 and provides telemedicine consultations to approximately 8.6% of the critically ill pediatric patients transferred from participating referring EDs (27). To request a consultation, a remote ED physician calls a toll-free number and a UC Davis pediatric critical care physician is then paged to initiate the consultation.…”

Section: Telemedicine Overviewmentioning

confidence: 99%

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Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children’s Hospital PICU*

Dayal

Hojman

Kissee

et al. 2016

Pediatric Critical Care Medicine

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Objectives: To compare the severity of illness and outcomes among children admitted to a children’s hospital PICU from referring emergency departments with and without access to a pediatric critical care telemedicine program. Design: Retrospective cohort study. Setting: Tertiary academic children’s hospital PICU. Patients: Pediatric patients admitted directly to the PICU from referring emergency departments between 2010 and 2014. Interventions: None. Measurements: Demographic factors, severity of illness, and clinical outcomes among children receiving care in emergency departments with and without access to pediatric telemedicine, as well as a subcohort of children admitted from emergency departments before and after the implementation of telemedicine. Main Results: Five hundred eighty-two patients from 15 emergency departments with telemedicine and 524 patients from 60 emergency departments without telemedicine were transferred and admitted to the PICU. Children admitted from emergency departments using telemedicine were younger (5.6 vs 6.9 yr; p< 0.001) and less sick (Pediatric Risk of Mortality III score, 3.2 vs 4.0; p < 0.05) at admission to the PICU compared with children admitted from emergency departments without telemedicine. Among transfers from emergency departments that established telemedicine programs during the study period, children arrived significantly less sick (mean Pediatric Risk of Mortality III scores, 1.2 units lower; p = 0.03) after the implementation of telemedicine (n = 43) than before the implementation of telemedicine (n = 95). The observed-to-expected mortality ratios of posttelemedicine, pretelemedicine, and no-telemedicine cohorts were 0.81 (95% CI, 0.53–1.09), 1.07 (95% CI, 0.53–1.60), and 1.02 (95% CI, 0.71–1.33), respectively. Conclusions: The implementation of a telemedicine program designed to assist in the care of seriously ill children receiving care in referring emergency departments was associated with lower illness severity at admission to the PICU. This study contributes to the body of evidence that pediatric critical care telemedicine programs assist referring emergency departments in the care of critically ill children and could result in improved clinical outcomes.

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“…Puede ocurrir a través de radios de dos vías, teléfonos celulares o a través de la telepresencia. [77][78][79][80] El centro de expedición o de comunicaciones puede solicitar al centro de referencia registros médicos, imágenes radiológicas y resultados de laboratorio para que estén disponibles cuando llegue el equipo. El uso de la telepresencia con los hospitales derivantes permite el asesoramiento en el tratamiento del niño crítico, en tiempo real, con conocimiento del paciente (permite "ver" radiografías, ecografías y todo tipo de procedimientos que se estén realizando) desde el momento que arriba al hospital de baja complejidad, por parte de la UTIP que actúa como centro de expedición e integrantes del servicio que forman parte del equipo de transporte.…”

Section: Comunicaciónunclassified

Consenso sobre el traslado de niños críticamente enfermos Comité Nacional de Emergencias y Cuidados Críticos

2019

Arch Argent Pediat

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Comité Nacional de Emergencias y Cuidados Críticos* RESUMEN El mayor desarrollo y la creación de nuevas unidades de terapia intensiva pediátrica en los últimos años obligan a revisar la estructuración adecuada de los cuidados correspondientes entre la reanimación inicial del paciente grave y la atención por especialistas en ámbitos de alta complejidad. El proceso de transporte debe ofrecer al paciente grave un estándar de cuidado similar al que se le ofrece en dicha Unidad. Este se logra con un equipo entrenado en el transporte pediátrico y con capacidad de proveer cuidados críticos. La decisión de transportar a un paciente dentro del mismo hospital o a otra institución se basa en la evaluación de los potenciales beneficios sopesados contra potenciales riesgos, ya que existe un incremento de la morbilidad y la mortalidad durante el transporte. Las recomendaciones que se presentan en este documento tienen el objetivo de intentar mejorar el traslado de pacientes críticos en nuestro país. Palabras clave: transportes, pediatría, cuidados críticos, transferencia de pacientes.

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Pediatric Critical Care Telemedicine Program: A Single Institution Review

Cited by 28 publications

References 17 publications

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study

Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children’s Hospital PICU*

Consenso sobre el traslado de niños críticamente enfermos Comité Nacional de Emergencias y Cuidados Críticos

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