Clinical Services

ePoster Presentation

(EP-113) Implementation of Telemedicine in Pediatric Patient Transport

Monday, April 24
10:01 AM - 10:15 AM
Location: Experience Zone - ePosters

Objectives
Telemedicine uses video technology to communicate visual clinical information about patients. While shown to be a feasible model in pediatric transport, our institution has experienced implementation barriers in the past. The purpose of this study was to implement telemedicine in pediatric transport at a tertiary children's hospital, assess its value in specific pediatric conditions and identify barriers to use.

Methods
This was a prospective study at Saint Louis Children's Hospital. The workflows of six divisions involved in pediatric transport (Emergency Department (ED), Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), Pediatric Hospitalists, Transport Team (TT), and Children’s Direct (CD) nurse communications specialists) were examined. A pre-implementation survey assessed attitudes towards telemedicine and elicited feedback about perceived barriers. The TT was equipped with smartphones and tablets and workstations were set up in the ED, PICU, and NICU. All 184 users were trained to use a software-based telemedicine platform on workstations and personal devices. CD prompted a video connection between the TT and the physician in transports for all transports for a 3-month period. Users reverted to phone communication if connection issues occurred. Survey results were collected on the usefulness of telemedicine and hindrance to workflow. A post-implementation survey assessed attitudes toward telemedicine and when this technology was most useful.

Results
Our pre-implementation survey demonstrated that 82% of users had never used telemedicine before this study. Physicians predicted greater utility of telemedicine and TT anticipated greater burden to workflow and less utility. During our study period, telemedicine communication was offered 67% of the time, initiated in 50% of cases and successful in 32% of cases. The largest barrier was connectivity in some remote locations. Over time, there was a trend toward users self-selecting patients for whom they believed telemedicine would be most useful, and both TT and physicians found it progressively more useful and less burdensome. Interestingly, the total successful connection rate remained the same throughout the study period. We will present data showing the relationship between patient disease type/severity and perceived usefulness of telemedicine as well as individual cases where telemedicine changed the management or disposition of the patient.

Conclusion
This prospective study successfully implemented telemedicine in pediatric transport. In this pilot study, we effectively incorporated telemedicine into our workflow. Telemedicine was more useful in transport of patients with more severe illness, and in some cases changed management. Future directions will include further implementation to focus on the most useful cases, improve connectivity issues, and continue user education.

Alison Curfman

Alison Curfman
Washington University in St. Louis

Dr. Alison Curfman is completing fellowship in Pediatric Emergency Medicine at Washington University in St. Louis. She has taken a position as Medical Director for Pediatric Telemedicine for the Mercy Hospital system - a large hospital system known for the Mercy Virtual Care Center, the only freestanding telehealth hospital in the country.

Alison is the co-founder and Vice-Chair of SPROUT, a multi-center research network dedicated to high quality pediatric telehealth research. This year she co-authored the chapter “Pediatric Emergency and Critical Care Telemedicine” for the McGraw Hill textbook Understanding Telehealth.

Alison is completing an MBA at the University of Wisconsin and devoting her career to developing sustainable, successful telehealth programs for pediatrics. She is committed to the highest quality of clinical care, antibiotic stewardship, patient safety, and advocating for the patient-centered medical home. Alison is passionate about health policy, and is excited for the opportunity to advocate for strong pediatric telehealth practices.

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Jacob Groenendyk

Medical Student
Washington University School of Medicine

N/A

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Celeste Brancato

Celeste C. Brancato, MD
Washington University School of Medicine

Practicing Pediatric Intensivist since 2009 after attending the University of Iowa for Medical School. My residency and fellowship were at St. Louis Children's Hospital affiliated with Washington University School of Medicine. It's been my pleasure to stay on with Washington University as an Assistant Professor and with St. Louis Children's Hospital as the Medical Director of Pediatric Transport Services.

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Scott Saunders

Associate Professor
Washington University

I am Associate Professor of Pediatrics and Developmental Biology at Washington University School of Medicine. An attending physician in the Neonatal Intensive Care Unit of St. Louis Children's Hospital as well as Medical Director of the Critical Care Transport Team.

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Chris Markham

Chris Markham
Washington University in St. Louis

Undergraduate and medical school training at Washington University. Residency and fellowship at St. Louis Children's Hospital. Chief fellow in pediatric critical care medicine.

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