Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Colorado Springs Campus, Colorado Springs, CO.
Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Colorado Springs, CO; Children's Hospital Colorado-Anschutz Medical Campus, Aurora, CO.
J Pediatr. 2023 Nov;262:113341. doi: 10.1016/j.jpeds.2023.01.015. Epub 2023 Feb 2.
To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency.
Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions.
In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians.
Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.
评估一家地区儿童医院新型远程医疗儿科胃肠病学（GI）咨询服务在接受程度、实用性、质量、可持续性和提供者弹性方面的情况。
2020 年 7 月至 2021 年 6 月期间，在一家地区儿童医院接受 GI 治疗的患者由具有医师助理支持的亲自就诊或远程医疗医生进行治疗，根据每周预设的人员配备计划随机分配。根据 RE-AIM（覆盖范围、效果、采用、实施和维持）和 STEM（SPROUT 远程医疗评估和管理）框架进行回顾性多领域计划评估，使用统计分析比较患者队列，并进行匿名调查以评估提供者的看法。
共为 348 名患者提供了 1051 天的 GI 护理，其中 17%通过远程医疗，83%为亲自就诊。两组患者在诊断、转院或再入院率方面无显著差异。除了需要访问地区医院无法提供的专门服务外，没有因其他原因进行转院。远程医疗医生的日常咨询工作量略大。初级和咨询团队的提供者接受了这种做法。该模式在第一年之后仍在继续。共有 75%的当地 GI 医生报告称，在将 20%的住院会诊周转移给另一个校区的医生后，他们的Brief Resilience Scores 有所提高。
在地区医院通过远程医疗提供间歇性儿科 GI 咨询服务得到了很好的接受、有用且可持续，并且提高了医生的适应能力，没有出现不良后果。远程医疗有望在医院之间利用儿科专家医生，使复杂的患者能够更接近家庭接受治疗，同时减少较小医生群体的住院覆盖需求。
