The Impact of Telemedicine Intensivist Support and a Pediatric Hospitalist Program on a Community Hospital

LaBarbera, Jaclin M.; Ellenby, Miles; Bouressa, Paul; Burrell, Jill; Flori, Heidi R.; Marcin, James P.

doi:10.1089/tmj.2012.0303

Cited by 45 publications

(32 citation statements)

References 22 publications

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“…Improving the initial care that these children receive in referring EDs could likely improve clinical outcomes and reduce burdens associated with increased morbidity, length of stay, and mortality (30,31). In the case of children who are not critically ill, appropriate pretransfer care might also prevent unnecessary and resource-intensive emergency transportation to a distant and possibly overcrowded PICU (20,22,23,32).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

“…Pediatric telemedicine consultations can sometimes obviate unnecessary transfers (20)(21)(22)(23), facilitate timely and appropriate stabilization prior to and during the transfer process (22,23), and may result in lower severity of illness at admission to the PICU and improved outcomes.…”

mentioning

confidence: 99%

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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“…155,171 Using telemedicine to assist in the management of some of these less ill children can result in high-quality care provided with shorter lengths of stay, less resource use, and lower costs. 70,172,173 It is therefore logical that some mildly or moderately ill children (eg, a child with a ventricular septal defect with asthma or a child with Kawasaki disease) can be cared for by local pediatric nurses and physicians with supervision from a regional children's hospital pediatric cardiology team using telemedicine and RM. 30,70,159,173 Telemedicine can be used by pediatric cardiologists through a broad range of applications to assist in the care of hospitalized children in a variety of clinical scenarios.…”

Section: Telemedicine In the Intensive Care Settingmentioning

confidence: 99%

“…70,172,173 It is therefore logical that some mildly or moderately ill children (eg, a child with a ventricular septal defect with asthma or a child with Kawasaki disease) can be cared for by local pediatric nurses and physicians with supervision from a regional children's hospital pediatric cardiology team using telemedicine and RM. 30,70,159,173 Telemedicine can be used by pediatric cardiologists through a broad range of applications to assist in the care of hospitalized children in a variety of clinical scenarios. 165,174 Physician consultations, nurse and physician monitoring, and medical oversight can range from a simple model of intermittent, need-based consultations (reactive model) to a model that integrates continuous oversight via monitoring and proactive medical decision making (continuous model).…”

Section: Telemedicine In the Intensive Care Settingmentioning

confidence: 99%

“…Previous studies have demonstrated that the use of telemedicine in the ED to deliver critical care consultations is similar to in-person consultations when diagnostic accuracy, treatment plans, and plans for disposition are compared. 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.…”

Section: Telecardiology In the Edmentioning

confidence: 99%

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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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Telemedicine in Acute Settings and Secondary Care: The Hospital

Capello

Pili

2014

Telemedicine for Children's Health

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The Impact of Telemedicine Intensivist Support and a Pediatric Hospitalist Program on a Community Hospital

Abstract: Telemedicine consultation between pediatric intensivists and community hospital physicians combined with a pediatric hospitalist program at the community hospital has the potential to improve triage of pediatric patients and reduce the need to transfer patients.

Cited by 45 publications

References 22 publications

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

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

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

Telemedicine in Acute Settings and Secondary Care: The Hospital

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