Heath Barry, Salerno Richard, Hopkins Amelia, Hertzig Jeremy, Caputo Michael
Division of Inpatient and Critical Pediatrics, Department of Pediatrics, University of Vermont College of Medicine and Vermont Children's Hospital at Fletcher Allen Health Care, Burlington, VT, USA.
Pediatr Crit Care Med. 2009 Sep;10(5):588-91. doi: 10.1097/PCC.0b013e3181a63eac.
A disparity in access to health care exists between rural and urban areas. Although 21% of children in the United States live in rural areas, only 3% of pediatric intensivists practice in rural areas. In an attempt to address this issue, we implemented a program of pediatric critical care telemedicine consultations in rural emergency departments (EDs) and report our results.
A prospective evaluation of pediatric critical care consultations in rural EDs was undertaken March 2006 through March 2008. A referral area with a population of 1,000,000 in 19 rural counties in Vermont and upstate New York comprised the study area.
Sixty-three telemedicine consultations were performed in 10 rural EDs. The average number of consultations was 6.3 per site (range 2-17). Minor technical issues were identified in 18 consultations (29%). There were 12 primary diagnoses. Telemedicine was used to supervise the critical care transport team on 25 occasions (40%). Consulting intensivists made 236 specific recommendations. Consulting intensivists thought that telemedicine consultations improved patient care 89% of the time, were superior to telephone consultations 91% of the time, and provided good to very good provider-to-provider communications 98% of the time. Referring providers reported that telemedicine consultations improved patient care 88% of the time, were superior to telephone consultations 55% of the time, and provided good to very good communications 94% of the time.
With telemedicine, it is feasible to provide urgent subspecialty critical care for children in underserved rural EDs, improve patient care, and provide a high degree of provider satisfaction. Pediatric critical care telemedicine may help to address the disparities in the access to and the outcome of medical care between rural and urban areas.
农村和城市地区在医疗保健可及性方面存在差异。尽管美国21%的儿童生活在农村地区，但仅有3%的儿科重症监护医师在农村地区执业。为解决这一问题，我们在农村急诊科实施了儿科重症监护远程医疗会诊项目并报告结果。
2006年3月至2008年3月对农村急诊科的儿科重症监护会诊进行前瞻性评估。研究区域包括佛蒙特州和纽约州北部19个农村县中人口达100万的一个转诊地区。
在10个农村急诊科进行了63次远程医疗会诊。每个地点的平均会诊次数为6.3次（范围为2 - 17次）。18次会诊（29%）中发现了轻微技术问题。有12种主要诊断。远程医疗在25次（40%）情况下用于监督重症监护转运团队。会诊重症监护医师提出了236条具体建议。会诊重症监护医师认为远程医疗会诊在89%的情况下改善了患者护理，在91%的情况下优于电话会诊，在98%的情况下提供了良好至极好的提供者间沟通。转诊提供者报告称，远程医疗会诊在88%的情况下改善了患者护理，在55%的情况下优于电话会诊，在94%的情况下提供了良好至极好的沟通。
借助远程医疗，为服务不足的农村急诊科儿童提供紧急专科重症监护、改善患者护理并使提供者满意度较高是可行的。儿科重症监护远程医疗可能有助于解决农村和城市地区在医疗保健可及性和医疗结果方面的差异。
