1Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC. 2Center for Telehealth, Medical University of South Carolina, Charleston, SC.
Pediatr Crit Care Med. 2017 Nov;18(11):e555-e560. doi: 10.1097/PCC.0000000000001330.
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.
Retrospective evaluation of consultations occurring between April 2012 and March 2016.
Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina.
Pediatric patients receiving critical care telemedicine or telephone consultations.
Telemedicine consultations.
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.
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.
研究儿科重症监护远程医疗咨询与农村急诊科分诊决策之间的关系。我们比较了一组接受重症监护远程医疗咨询的患者和一组接受电话咨询的患者的远程评估分诊位置和准确性。
2012 年 4 月至 2016 年 3 月间进行的咨询回顾性评估。
南卡罗来纳州 52 个农村医疗保健场所的儿科重症监护远程医疗和电话咨询。
接受重症监护远程医疗或电话咨询的儿科患者。
远程医疗咨询。
共收集了 484 次电话或远程医疗咨询的咨询提供者的数据。我们检查了提供者关于咨询、决策和分诊结果的自我评估。我们建立了一个对数模型，以预测远程医疗咨询的年龄和性别作为分诊位置的函数。对于远程医疗患者，与接受电话咨询的患者相比，分诊到非 ICU 级别的护理的可能性要高出 2.55 倍（p = 0.0005）。提供者认为通过远程医疗提供的评估更准确。当患者通过远程医疗咨询转移到非 ICU 位置时，95.7%（p < 0.001）的情况下，提供者表示远程医疗影响了分诊决策。对于转移到非 ICU 位置的患者，在 24 小时内转移到更高水平的护理并没有观察到增加。
向社区医院提供儿科重症监护远程医疗咨询是可行的，可减少 PICU 入院率。本研究表明，与电话相比，远程医疗可提高提供者报告的患者评估准确性，这可能会增加将患者转运至较低级别护理的舒适度。儿科重症监护远程医疗咨询代表了一种改善农村地区危重症儿童护理和降低成本的有前途的方法。
