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Telemedicine for Interfacility Nurse Handoffs*

Lieng, Monica K. BS; Siefkes, Heather M. MD, MSCI; Rosenthal, Jennifer L. MD, MAS; Sauers-Ford, Hadley S. MPH, CCRP; Mouzoon, Jamie L. MA; Sigal, Ilana S. MPH; Dayal, Parul MS; Chen, Shelby T. BS; McBeth, Cheryl L. RN, MSN; Dial, Sandie BSN; Dizon, Genevieve BSN; Dannewitz, Haley E. BSN; Kozycz, Kiersten BSN; Jennings-Hill, Torryn L. BSN; Martinson, Jennifer M. BSN; Huerta, Julia K. BSN, MPH; Pons, Emily A. BSN; Vance, Nicole BSN; Warnock, Breanna N. BSN; Marcin, James P. MD, MPH

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p 832-840
doi: 10.1097/PCC.0000000000002011
Quality and Safety

Objective: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone.

Design: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis.

Setting: Tertiary PICU within an academic children’s hospital.

Participants: PICU nurses who received a patient handoff between October 2017 and July 2018.

Interventions: None.

Main Results and Measurements: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55).

Conclusions: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

All authors: Department of Pediatrics, University of California Davis, School of Medicine, Davis, CA.

*See also p. 890.

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The telemedicine infrastructure for this study was developed with funds from grant number G01RH27872 from the Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy, Office for the Advancement of Telehealth and from grant number H3AMC24073 from HRSA, Maternal and Child Health Bureau, Emergency Medical Services for Children Program, and State Partnership Regionalization of Care.

Ms. Lieng’s institution received funding from National Center for Advancing Translational Sciences (NCATS) and National Institutes of Health (NIH)—grant number UL1 TR001860 and linked award TL1 TR001861 and KL2 TR001859. Ms. Lieng and Dr. Rosenthal received support for article research from the NIH. Dr. Rosenthal’s institution received funding from NCATS and NIH—grant number UL1 TR001860 and linked award KL2 TR001859. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies