Division of Pediatric Critical Care, Department of Pediatrics and Critical Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Division of Pediatric Critical Care, Department of Pediatrics, Cooper University Hospital, Camden, New Jersey.
Telemed J E Health. 2020 Jan;26(1):101-106. doi: 10.1089/tmj.2018.0190. Epub 2019 Mar 5.
At-home attending intensivists often must return to the hospital to assist residents. To determine if using telemedicine communication between in-house pediatric residents and at-home attending intensivists impacts the rate of attending return to the hospital and improves resident education. In this single-center prospective study at an academic children's hospital's pediatric intensive care unit (PICU), 40 patients younger than 18 years were randomized into video or telephone arms. Residents and intensivists completed anonymous surveys after each encounter. Video-conferencing encounters between residents and at-home, on-call intensivists were compared with standard telephone calls for admissions to PICU. Video and telephone arms had 21 and 19 patients enrolled, respectively. Data comparison was performed using Mann-Whitney U, chi-square, and Kruskal-Wallis analysis. Clinical illness severity rating for intensivists and residents was not significantly different for video communication compared with telephone (p = 0.63 and p = 0.42, respectively). Intensivists reported no significant difference in ease of use (p = 0.87). There was perceived improvement in resident education with the use of telemedicine (52.6% vs. 76.2%; p = 0.11). Video communication was easy to use but did not change the rating of illness severity or need for intensivist to return to the hospital. There was perceived improvement in resident education with the use of telemedicine, and it may serve as a useful tool in demonstrating acute clinical changes to out-of-hospital intensivists. Larger-scale studies in teaching hospitals with out-of-hospital pediatric intensivists need to be conducted to further evaluate the role of telemedicine in patient management and resident education.
家庭主治医生经常需要返回医院协助住院医生。为了确定家庭主治医生与住院医生之间使用远程医疗沟通是否会影响主治医生返回医院的频率，并改善住院医生的教育水平。在这项单中心前瞻性研究中，在一家学术儿童医院的儿科重症监护病房（PICU），将 40 名年龄小于 18 岁的患者随机分配到视频或电话组。住院医生和主治医生在每次就诊后完成匿名调查。将住院医生和在家待命的主治医生之间的视频会议与标准电话进行比较，以确定患者是否需要收入 PICU。视频组和电话组分别有 21 名和 19 名患者入组。使用 Mann-Whitney U、卡方和 Kruskal-Wallis 分析比较数据。与电话相比，视频通信对主治医生和住院医生的临床疾病严重程度评分没有显著差异（p=0.63 和 p=0.42）。主治医生报告说，易用性没有明显差异（p=0.87）。使用远程医疗可以改善住院医生的教育（52.6%比 76.2%；p=0.11）。视频通信易于使用，但不会改变主治医生对疾病严重程度的评估或需要返回医院的情况。使用远程医疗可以改善住院医生的教育，并且它可以作为向院外主治医生展示急性临床变化的有用工具。需要在有院外儿科主治医生的教学医院进行更大规模的研究，以进一步评估远程医疗在患者管理和住院医生教育中的作用。
