Otero Andrea Victoria, Lopez-Magallon Alejandro Jose, Jaimes Diana, Motoa Maria Victoria, Ruz Miguel, Erdmenger Julio, Muñoz Ricardo A
1 Division of Pediatric Cardiac Critical Care, Children's Hospital of the University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
Telemed J E Health. 2014 Jul;20(7):619-25. doi: 10.1089/tmj.2013.0307. Epub 2014 Jun 5.
To describe our multicenter experience in telemedicine-assisted pediatric cardiac critical care (PCCC) with four hospitals in Latin America from July 2011 to June 2013.
This was a descriptive study based on telemedicine encounters related to quality of communication, assessed information, activities, and recommendations. Comparison among centers was performed. A postimplementation survey was conducted through a 5-point Likert scale questionnaire investigating acceptance among professionals involved with the telemedicine service through the assessment of general satisfaction, perception about the work system, usefulness, and impact on medical practice.
One thousand forty consultations were conducted for 476 patients. Postoperatively, patients were distributed into Risk Adjustment Classification for Congenital Heart Surgery (RACHS-1) categories as follows: 2%, 26%, 36%, 26%, and 10% in categories 1, 2, 3, 4, and 6, respectively. A real-time intervention took place in 23% of encounters. Of the 2,173 recommendations given, 70 were related to extracorporeal membrane oxygenation management. There was a different RACHS-1 distribution and encounter characteristics among centers. From a total of 51 surveys sent, 27 responses were received, and among responders, overall satisfaction was very high (4.27 ± 0.18), as well as work system quality (4.4 ± 0.37). Telemedicine was considered useful in the cardiac intensive care unit (3.86 ± 0.60), for patient outcomes (3.8 ± 0.51), and for education (3.7 ± 0.71). There was a difference in overall satisfaction, perception about telemedicine usefulness in education, and impact on medical practice among centers.
An international, multicenter telemedicine program in PCCC is technologically and logistically feasible. Prospective interventions in our international multicenter telemedicine program should consider differences in staff composition, perception of needs, and patient population among centers.
描述2011年7月至2013年6月我们在拉丁美洲四家医院开展的远程医疗辅助小儿心脏重症监护（PCCC）的多中心经验。
这是一项基于远程医疗会诊的描述性研究，涉及沟通质量、评估信息、活动及建议。对各中心进行了比较。通过五点李克特量表问卷进行实施后调查，通过评估总体满意度、对工作系统的认知、实用性以及对医疗实践的影响，调查参与远程医疗服务的专业人员的接受程度。
为476例患者进行了1040次会诊。术后，患者按先天性心脏病手术风险调整分类（RACHS-1）类别分布如下：1类、2类、3类、4类和6类分别占2%、26%、36%、26%和10%。23%的会诊进行了实时干预。在给出的2173条建议中，70条与体外膜肺氧合管理有关。各中心之间的RACHS-1分布和会诊特征存在差异。共发送了51份调查问卷，收到27份回复，在回复者中，总体满意度非常高（4.27±0.18），工作系统质量也很高（4.4±0.37）。远程医疗在心脏重症监护病房（3.86±0.60）、对患者预后（3.8±0.51）以及教育方面（3.7±0.71）被认为是有用的。各中心在总体满意度、对远程医疗在教育方面的实用性认知以及对医疗实践的影响方面存在差异。
PCCC中的国际多中心远程医疗项目在技术和后勤方面是可行的。我们国际多中心远程医疗项目中的前瞻性干预应考虑各中心在人员构成、需求认知和患者群体方面的差异。
