Kovacikova Lubica, Zahorec Martin, Skrak Peter, Hanna Brian D, Lee Vogel R
Pediatric Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Congenit Heart Dis. 2017 Jul;12(4):491-496. doi: 10.1111/chd.12480. Epub 2017 May 19.
Telemedicine is a rapidly evolving form of modern information and communication technology used to deliver clinical services and educational activities.
The aim of this article is to report and analyze our experience with transatlantic consultation via videoconferencing in pediatric cardiology.
In February, 2013, videoconferencing project was launched between a medium-volume pediatric cardiac center in Bratislava, Slovakia and subspecialty experts from a high-volume pediatric cardiac program at The Children's Hospital of Philadelphia (CHOP), USA. During 1.5-2 hours videoconferences, 2-3 patients with similar complex clinical scenarios were presented to CHOP experts. The main goal of the project was consultation on individual patients to validate, alter or radically change clinical management plans.
From February, 2013 to January, 2017, 25 videoconferences occurred and 73 cases were discussed. The median patient age was 52 months (range; 1 day-30 years). Forty-six discussed cases were outpatients, 21 patients were in the intensive care unit and 6 patients were discussed post mortem. Thirty-one CHOP experts from different subspecialties participated actively in patient consultations. The most frequent recommendations were related to single ventricle, pulmonary hypertension or heart failure patients and intervention in complex and/or rare cardiac diseases. Specialists from CHOP agreed completely with the original care plan in 16% of cases. In 52% cases, adjustments to original plan were suggested. Radical changes were recommended in 30% of cases. Receiving institution adopted recommendations to the patient care fully in 79% and partially in 13% of patients.
Based on our 4-year experience we consider videoconferencing between medium-size pediatric cardiac center and subspecialty experts from a high-volume pediatric cardiac program a suitable form of medical consultations. Videoconferencing assists in clinical decision making for complex patient cases and serves as an effective educational tool to gain knowledge and experience "without borders."
远程医疗是一种迅速发展的现代信息和通信技术形式，用于提供临床服务和教育活动。
本文旨在报告并分析我们在儿科心脏病学领域通过视频会议进行跨大西洋会诊的经验。
2013年2月，斯洛伐克布拉迪斯拉发一家中等规模的儿科心脏中心与美国费城儿童医院（CHOP）一个大规模儿科心脏项目的专科专家之间启动了视频会议项目。在1.5至2小时的视频会议期间，向CHOP专家介绍了2至3例具有相似复杂临床情况的患者。该项目的主要目标是对个体患者进行会诊，以验证、改变或彻底改变临床管理计划。
从2013年2月至2017年1月，共进行了25次视频会议，讨论了73例病例。患者的中位年龄为52个月（范围：1天至30岁）。讨论的46例病例为门诊患者，21例患者在重症监护病房，6例病例是在患者死后进行讨论的。来自不同专科的31位CHOP专家积极参与了患者会诊。最常见的建议涉及单心室、肺动脉高压或心力衰竭患者以及复杂和/或罕见心脏病的干预。CHOP的专家在16%的病例中完全同意原护理计划。在52%的病例中，建议对原计划进行调整。在30%的病例中建议进行彻底改变。接收机构在79%的患者中完全采纳了对患者护理的建议，在13%的患者中部分采纳。
基于我们4年的经验，我们认为中等规模的儿科心脏中心与大规模儿科心脏项目的专科专家之间的视频会议是一种合适的医学会诊形式。视频会议有助于对复杂患者病例进行临床决策，并作为一种有效的教育工具，实现“无国界”获取知识和经验。
