Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19401, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Cardiol. 2023 Jan;44(1):196-203. doi: 10.1007/s00246-022-02993-y. Epub 2022 Sep 1.
Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality; home monitoring programs have mitigated these risks. In 2019, we instituted telemedicine (TM) in our established Infant Single Ventricle Monitoring Program. All consecutive patients discharged following neonatal operation/intervention were monitored until subsequent stage 2 surgical palliation. We offered TM (synchronous video) visits as part of regularly scheduled follow-up, replacing at least one in-person primary care visit with a TM cardiologist visit. We tracked emergency department (ED) visits, hospitalizations, how TM identified clinical concerns, and whether use of TM prevented unnecessary ED visits or expedited in-person assessment. We assessed caregiver and clinician satisfaction. Between 8/2019 and 5/2020, we conducted 60 TM visits for 29 patients. Of 31 eligible patients, 2 families (6.9%) declined. Median monitoring time was 199 days (range 75-264) and median number of TM visits/patient was 2 (range 1-5). In 6 visits (10%), significant clinical findings were identified which avoided an ED visit. Five TM visits led to expedited outpatient assessments, of which 1 patient required hospitalization. There were no missed events or deaths. Median ED visits/patient/month were significantly lower compared to the same calendar period of the prior year (0.0 (0-2.5) vs. 0.4 (0-3.7), p = 0.0004). Caregivers and clinicians expressed high levels of satisfaction with TM. TM for this high-risk population is feasible and effective in identifying clinical concerns and preventing unnecessary ED visits. TM was particularly effective during the COVID-19 pandemic, allowing for easy adaptation of care to ensure patient safety in this fragile cohort.
患有先天性心脏病的分期手术姑息治疗的婴儿在围手术期有较高的发病率和死亡率风险；家庭监测计划已经降低了这些风险。2019 年，我们在已建立的婴儿单心室监测计划中引入了远程医疗（TM）。所有在新生儿手术后/介入后出院的连续患者都在接受监测，直到进行下一次 2 期手术姑息治疗。我们提供 TM（同步视频）就诊作为定期随访的一部分，用 TM 心脏病专家就诊代替至少一次常规的初级保健就诊。我们跟踪了急诊部（ED）就诊、住院情况、TM 如何识别临床问题，以及 TM 是否能避免不必要的 ED 就诊或加快门诊评估。我们评估了护理人员和临床医生的满意度。在 2019 年 8 月至 2020 年 5 月期间，我们为 29 名患者进行了 60 次 TM 就诊。在 31 名符合条件的患者中，有 2 个家庭（6.9%）拒绝了。中位监测时间为 199 天（范围 75-264），中位 TM 就诊次数/患者为 2 次（范围 1-5）。在 6 次就诊（10%）中，发现了有意义的临床发现，避免了 ED 就诊。有 5 次 TM 就诊导致了门诊评估的加快，其中 1 名患者需要住院治疗。没有漏诊事件或死亡。与前一年同期相比，患者每月 ED 就诊次数明显减少（0.0（0-2.5）vs. 0.4（0-3.7），p = 0.0004）。护理人员和临床医生对 TM 表达了高度的满意度。TM 对于这种高危人群是可行且有效的，可以识别临床问题并避免不必要的 ED 就诊。在 COVID-19 大流行期间，TM 特别有效，使我们能够轻松地调整护理方式，确保这一脆弱群体的患者安全。
