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Low Utilization of Synchronous Telemedicine in Pediatric Critical Care Interfacility Transport: Barriers and Lessons
Stephen J Gleich1, Lucas A Myers2, Megan D Montgomery3
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Insights
Synchronous telemedicine use in pediatric transport is low due to connectivity issues and physician workload. Future research should address these barriers for improved critically ill child care.
Area of Science:
- Pediatric critical care
- Medical transport
- Telemedicine
Background:
- Telemedicine use is increasing and may improve care for children during medical transport.
- Evaluating synchronous telemedicine feasibility is crucial for interfacility transport of critically ill children.
Purpose of the Study:
- To assess the feasibility of synchronous telemedicine for critically ill children during interfacility transport by a pediatric transport team.
Main Methods:
- Prospective, observational feasibility study (2019-2020).
- Introduction of synchronous telemedicine into a pediatric transport team.
- Outcomes: connectivity, physician workload, team satisfaction, patient care.
Main Results:
- Telemedicine considered in 19% of 118 transports; connection attempted in 11.
- Median connection time: 2.9 minutes; 18.2% connection failure rate.
- Physician workload prevented activation in 50%; 41.7% reported no perceived benefit.
Conclusions:
- Low utilization of synchronous telemedicine in interfacility pediatric transport.
- Barriers include connectivity, physician workload, and low perceived benefit.
- Future research needed to mitigate identified barriers.
Objective:
The use of telemedicine has increased and may enhance the care of children during medical transport. We aimed to evaluate the feasibility of synchronous telemedicine connectivity before interfacility transport of critically ill children by a pediatric transport team.
Methods:
We performed a prospective, observational feasibility study of the introduction of synchronous telemedicine into an established pediatric transport team from 2019 to 2020. The outcomes examined included connectivity, physician workload, transport team satisfaction, and patient care outcomes.
Results:
Among 118 eligible transports, telemedicine was considered in 23 transports (19%), including 11 transports in which an attempt to connect was sought and 12 in which telemedicine activation was offered but not attempted. The median connection time was 2.9 minutes (interquartile range, 1.7-4.4 minutes), and clinical care was altered in 1 case. Connection failed in 2 cases (18.2%). In 50% of cases, concurrent medical control physician workload prevented activation. There were no perceived benefits in 41.7% of cases. Team members indicated the desire for future telemedicine use in only 54.6% of cases.
Conclusions:
We found low utilization of synchronous telemedicine in interfacility pediatric transport. The identified barriers included reliable connectivity, physician workload, and low perceived benefit. Lessons learned and future research suggestions are presented to mitigate these barriers.
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