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International telemedicine in pediatric cardiac critical care: a multicenter experience
Andrea Victoria Otero1, Alejandro Jose Lopez-Magallon, Diana Jaimes
11 Division of Pediatric Cardiac Critical Care, Children's Hospital of the University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
Insights
Telemedicine in pediatric cardiac critical care (PCCC) is feasible across multiple Latin American centers. This program demonstrated high professional satisfaction and usefulness in improving patient care and education.
Area of Science:
- Cardiology
- Critical Care Medicine
- Telemedicine
Background:
- Pediatric cardiac critical care (PCCC) presents unique challenges in resource-limited settings.
- Telemedicine offers a potential solution to extend specialized care and expertise.
Purpose of the Study:
- To evaluate the feasibility and impact of a multicenter telemedicine program in PCCC across four Latin American hospitals.
- To assess the quality of communication, information, activities, and recommendations during telemedicine encounters.
Main Methods:
- A descriptive study of telemedicine encounters from July 2011 to June 2013.
- Analysis of encounter characteristics, recommendations, and patient risk stratification (RACHS-1).
- Postimplementation survey using a 5-point Likert scale to assess professional satisfaction and perceived impact.
Main Results:
- 1,040 consultations for 476 patients were conducted.
- Real-time interventions occurred in 23% of encounters, with 70 recommendations for extracorporeal membrane oxygenation (ECMO) management.
- High overall satisfaction (4.27/5) and perceived usefulness in the cardiac intensive care unit (3.86/5), patient outcomes (3.8/5), and education (3.7/5) were reported.
Conclusions:
- An international, multicenter telemedicine program in PCCC is technologically and logistically feasible.
- Future interventions should account for inter-center variations in staff, perceived needs, and patient populations.
Objective:
To describe our multicenter experience in telemedicine-assisted pediatric cardiac critical care (PCCC) with four hospitals in Latin America from July 2011 to June 2013.
Materials And Methods:
This was a descriptive study based on telemedicine encounters related to quality of communication, assessed information, activities, and recommendations. Comparison among centers was performed. A postimplementation survey was conducted through a 5-point Likert scale questionnaire investigating acceptance among professionals involved with the telemedicine service through the assessment of general satisfaction, perception about the work system, usefulness, and impact on medical practice.
Results:
One thousand forty consultations were conducted for 476 patients. Postoperatively, patients were distributed into Risk Adjustment Classification for Congenital Heart Surgery (RACHS-1) categories as follows: 2%, 26%, 36%, 26%, and 10% in categories 1, 2, 3, 4, and 6, respectively. A real-time intervention took place in 23% of encounters. Of the 2,173 recommendations given, 70 were related to extracorporeal membrane oxygenation management. There was a different RACHS-1 distribution and encounter characteristics among centers. From a total of 51 surveys sent, 27 responses were received, and among responders, overall satisfaction was very high (4.27 ± 0.18), as well as work system quality (4.4 ± 0.37). Telemedicine was considered useful in the cardiac intensive care unit (3.86 ± 0.60), for patient outcomes (3.8 ± 0.51), and for education (3.7 ± 0.71). There was a difference in overall satisfaction, perception about telemedicine usefulness in education, and impact on medical practice among centers.
Conclusions:
An international, multicenter telemedicine program in PCCC is technologically and logistically feasible. Prospective interventions in our international multicenter telemedicine program should consider differences in staff composition, perception of needs, and patient population among centers.
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