OBJECTIVE: To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. DESIGN: Retrospective evaluation of consultations occurring between April 2012 and March 2016. SETTING: Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. PATIENTS: Pediatric patients receiving critical care telemedicine or telephone consultations. INTERVENTION: Telemedicine consultations. MEASUREMENTS AND MAIN RESULTS: Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p < 0.001). For patients transferred to a non-ICU location, an increase in transfers to a higher level of care within 24 hours was not observed. CONCLUSION: Pediatric critical care telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.
OBJECTIVE: To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. DESIGN: Retrospective evaluation of consultations occurring between April 2012 and March 2016. SETTING: Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. PATIENTS: Pediatric patients receiving critical care telemedicine or telephone consultations. INTERVENTION: Telemedicine consultations. MEASUREMENTS AND MAIN RESULTS: Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p < 0.001). For patients transferred to a non-ICU location, an increase in transfers to a higher level of care within 24 hours was not observed. CONCLUSION: Pediatric critical care telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.
Authors: Monica K Lieng; Heather M Siefkes; Jennifer L Rosenthal; Hadley S Sauers-Ford; Jamie L Mouzoon; Ilana S Sigal; Parul Dayal; Shelby T Chen; Cheryl L McBeth; Sandie Dial; Genevieve Dizon; Haley E Dannewitz; Kiersten Kozycz; Torryn L Jennings-Hill; Jennifer M Martinson; Julia K Huerta; Emily A Pons; Nicole Vance; Breanna N Warnock; James P Marcin Journal: Pediatr Crit Care Med Date: 2019-09 Impact factor: 3.624
Authors: Jennifer L Rosenthal; Hadley S Sauers-Ford; Moina Snyder; Michelle Y Hamline; Angela S Benton; Sharon Joo; JoAnne E Natale; Jennifer L Plant Journal: Telemed J E Health Date: 2020-06-22 Impact factor: 3.536
Authors: Christina Tsou; Suzanne Robinson; James Boyd; Andrew Jamieson; Robert Blakeman; Justin Yeung; Josephine McDonnell; Stephanie Waters; Kylie Bosich; Delia Hendrie Journal: J Med Internet Res Date: 2021-11-26 Impact factor: 5.428
Authors: Douglas A Colquhoun; Ryan P Davis; Theodore T Tremper; Jenny J Mace; Jan M Gombert; William D Sheldon; Joseph J Connolly; Justin F Adams; Kevin K Tremper Journal: BMC Anesthesiol Date: 2021-07-24 Impact factor: 2.217