Nighttime telecommunication between remote staff intensivists and bedside personnel in a pediatric intensive care unit: a retrospective study.

OBJECTIVE

To investigate the hypothesis that nighttime telemedicine can help staff intensivists remotely manage patients in a pediatric intensive care unit, preserve continuity of care, communicate with the bedside team, and provide reassurance to families in a unit where fellows provide nighttime, onsite care, with supervision by staff intensivists available by pager.

DESIGN

A retrospective review.

SETTING

A pediatric intensive care unit in an academic, tertiary medical center with telemedicine capability, including a mobile telemedicine cart in the pediatric intensive care unit and a home-based unit for each pediatric staff intensivist.

PATIENTS

Critically ill pediatric patients between 0 and 19 yrs, who were admitted to the pediatric intensive care unit between May 2010 and July 2011 and were managed via telemedicine.

INTERVENTIONS

Consecutive intake forms completed by staff intensivists following each telemedicine encounter were reviewed.

MAIN RESULTS

Fifty-six consecutive intake forms were evaluated for the study period. Connectivity was established in 95% of attempts. Audio and video qualities were excellent 94% and 85% of the time, respectively. The median call duration was 15 mins. The pediatric critical care fellow was present for 100% of calls, nurses 68%, and parents 66%. Reasons for initiating the call were "patient assessment" (98%), "team meeting" (25%), and/or parent update (40%). "Patient assessment," "communication with multidisciplinary care team," and "communication with a patient's family" were the outcomes most often cited that would not have been possible via telephone. A change in medical management was noted following 32% of encounters.

CONCLUSIONS

This study demonstrates that nighttime telecommunication linking staff intensivists on home-call with pediatric intensive care unit bedside care providers, patients, and their families is technologically feasible and may enhance team communication, provide reassurance to families, and impact patient management.