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Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility*

Berrens, Zachary J., MD, MPH1; Gosdin, Craig H., MD2,3; Brady, Patrick W., MD2,3; Tegtmeyer, Ken, MD1,3

Pediatric Critical Care Medicine: February 2019 - Volume 20 - Issue 2 - p 172–177
doi: 10.1097/PCC.0000000000001796
Quality and Safety

Objectives: Satellite inpatient facilities of larger children’s hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children’s hospital. Herein, we compare this model with our in-person model at our main campus.

Design: Cross-sectional.

Setting: A tertiary pediatric center and its satellite facility.

Patients: Patients admitted to the satellite facility.

Interventions: Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support.

Measurements and Main Results: We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model.

Main Results: Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45–55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation.

Conclusions: Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities.

1Department of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

2Department of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

*See also p. 198.

Dr. Brady disclosed that he is supported by a career development award from Agency for Healthcare Research and Quality, and he received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Cincinnati Children’s Hospital Medical Center.

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