儿科重症监护医师远程医疗参与卫星设施快速反应团队和急救响应的疗效和安全性。

Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility.

机构信息

Department of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Department of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

出版信息

Pediatr Crit Care Med. 2019 Feb;20(2):172-177. doi: 10.1097/PCC.0000000000001796.

DOI:10.1097/PCC.0000000000001796

PMID:30395026

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6363847/

Abstract

OBJECTIVES

Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus.

DESIGN

Cross-sectional.

SETTING

A tertiary pediatric center and its satellite facility.

PATIENTS

Patients admitted to the satellite facility.

INTERVENTIONS

Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support.

MEASUREMENTS AND MAIN RESULTS

We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model.

MAIN RESULTS

Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation.

CONCLUSIONS

Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities.

摘要

目的

较大型儿童医院的卫星住院设施通常没有现场重症监护支持。内部快速反应小组和代码小组可能难以在这些设施中运作。我们开发了一种使用远程医疗的系统，为儿童医院卫星设施的快速反应小组和代码小组提供儿科重症监护支持。在此，我们将该模型与我们在主校区的现场模型进行了比较。

设计

横断面。

地点

三级儿科中心及其卫星设施。

患者

入住卫星设施的患者。

干预措施

在卫星设施中实施快速反应小组和代码小组模型，使用远程医疗提供重症监护支持。

测量和主要结果

我们通过三个事先确定的结果评估远程医疗模型的成功：1）可靠性：重症监护医生参与远程医疗快速反应小组和代码，2）效率：快速反应小组和代码呼叫到重症监护医生响应的时间，以及 3）结果：远程医疗快速反应小组或代码呼叫的处置。我们将每个指标从我们的远程医疗模型与我们的既定主校区模型进行了比较。

主要结果

卫星校园快速反应小组激活时重症监护得到可靠参与（94.6%的时间）。该过程效率高（中位数反应时间为 7 分钟；平均 8.44 分钟）且有效（54.5%的患者转至 PICU，与主校区每月 45-55%的比例相似）。对于代码激活，重症监护远程医疗响应率为 100%（6/6），响应时间快（中位数 1.5 分钟）。我们没有发现患者的风险增加，没有从卫星校园转来的患者需要快速升级治疗，定义为开始血管活性支持、液体复苏超过 60ml/kg 或气管插管。