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Pediatric critical care telemedicine in rural underserved emergency departments*

Heath, Barry MD, FCCM; Salerno, Richard MD, MS; Hopkins, Amelia MD; Hertzig, Jeremy MD; Caputo, Michael MS

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3181a63eac
Clinical Investigation
Abstract

Objective: A disparity in access to health care exists between rural and urban areas. Although 21% of children in the United States live in rural areas, only 3% of pediatric intensivists practice in rural areas. In an attempt to address this issue, we implemented a program of pediatric critical care telemedicine consultations in rural emergency departments (EDs) and report our results.

Patients and Methods: A prospective evaluation of pediatric critical care consultations in rural EDs was undertaken March 2006 through March 2008. A referral area with a population of 1,000,000 in 19 rural counties in Vermont and upstate New York comprised the study area.

Measurements and Main Results: Sixty-three telemedicine consultations were performed in 10 rural EDs. The average number of consultations was 6.3 per site (range 2–17). Minor technical issues were identified in 18 consultations (29%). There were 12 primary diagnoses. Telemedicine was used to supervise the critical care transport team on 25 occasions (40%). Consulting intensivists made 236 specific recommendations. Consulting intensivists thought that telemedicine consultations improved patient care 89% of the time, were superior to telephone consultations 91% of the time, and provided good to very good provider-to-provider communications 98% of the time. Referring providers reported that telemedicine consultations improved patient care 88% of the time, were superior to telephone consultations 55% of the time, and provided good to very good communications 94% of the time.

Conclusions: With telemedicine, it is feasible to provide urgent subspecialty critical care for children in underserved rural EDs, improve patient care, and provide a high degree of provider satisfaction. Pediatric critical care telemedicine may help to address the disparities in the access to and the outcome of medical care between rural and urban areas.

Author Information

From the Division of Inpatient and Critical Pediatrics (BH, RS, AH, JH, MC), Department of Pediatrics, University of Vermont College of Medicine and Vermont Children’s Hospital at Fletcher Allen Health Care, Burlington, VT; Division of Pediatric Critical Care (JH), Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA; and Central Information Technology Services (MC), Washington University in St. Louis School of Medicine, St. Louis, MO.

Supported, in part, by a grant from the U.S. Department of Transportation (US DOT FAST STAR: Linking telemedicine to the moving ambulance. Continuation, project 1 of telemedicine and rural specialty care: a pilot study).

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: Barry.Heath@vtmednet.org

©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies