Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation
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Published on: April 7, 2023
Chris P Yang1, Elizabeth A Hunt, Nicole Shilkofski
1From the *Children's Respiratory and Critical Care Specialists, Minneapolis, MN; †Departments of Anesthesiology and Critical Care Medicine and ‡Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD; §Division of Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA; and ∥Divisions of Critical Care Medicine and Anesthesiology and Pain Medicine, Children's National Medical Center, Washington, DC.
Insights
Telemedicine consultation for critically ill children in community hospitals is feasible but did not improve adherence to resuscitation guidelines in this study. Further research is needed to optimize its impact on pediatric critical care quality.
Area of Science:
- Pediatric Critical Care Medicine
- Health Services Research
- Telemedicine
Background:
- Critically ill children transferred from community hospitals often have poorer outcomes due to lack of specialized care.
- Pediatric consultation and adherence to management guidelines are crucial for improving outcomes in these patients.
Purpose of the Study:
- To evaluate the feasibility of telemedicine consultation for pediatric critical care emergencies.
- To compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines.
Main Methods:
- A randomized controlled trial using in situ, high-fidelity simulation scenarios of critically ill children.
- Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention).
- Primary outcome was successful defibrillation within 180 seconds for pulseless ventricular tachycardia.
Main Results:
- No significant difference in successful defibrillation rates between telemedicine and telephone groups (33% vs. 40%).
- Telemedicine group showed significantly higher use of backboards during CPR (100% vs. 60%).
- Telemedicine group showed a trend towards increased use of stepstools during CPR (33% vs. 7%).
Conclusions:
- Telemedicine is a feasible tool to support acute pediatric care in community hospitals.
- This study did not demonstrate improved adherence to resuscitation guidelines with telemedicine consultation.
- Further research is warranted to optimize telemedicine's impact on pediatric critical care quality.
Objectives:
Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial.
Methods:
In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia.
Results:
The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07.
Conclusions:
This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at community hospitals is warranted.
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