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Pediatric Tele-Critical Care: Initial Experience with a Continuous Surveillance Model Aiming to Prevent Cardiac
Alejandro Lopez Magallon1,2, Lucas Saenz2, Rittal Mehta3
1Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.
Insights
Tele-critical care (TCC) in pediatric cardiac intensive care units (CICU) enhances patient safety. Virtual support improves early detection of concerning trends (CT), leading to interventions that potentially avoid cardiac arrest (CA).
Area of Science:
- Pediatric Critical Care Medicine
- Telemedicine
- Cardiology
Background:
- Cardiac arrest (CA) remains a significant risk in children with critical heart disease, despite treatment advancements.
- Virtual support models are emerging to enhance care in specialized intensive care units.
Purpose of the Study:
- To evaluate the impact of tele-critical care (TCC) on early detection of concerning trends (CT) and avoidance of CA in a pediatric cardiac intensive care unit (CICU).
- To analyze critical communications (CCs) between TCC and bedside teams (BTs).
Main Methods:
- A retrospective descriptive review of TCC activities from January 2019 to December 2022 in a pediatric CICU.
- Analysis of virtual surveillance workflows, including remote monitoring, patient room cameras, medical records, and AI tools.
- Examination of CCs to BTs, their responses, and related CA events.
Main Results:
- 18,171 TCC activities were conducted, with 248 critical communications (CCs).
- A significant increase in CCs related to concerning trends (CT), respiratory issues, and cardiac rhythm abnormalities was observed over time.
- Interventions following CCs included adjustments in medical treatment, respiratory support, and cardiac rhythm control.
Conclusions:
- Critical communications from TCC units in pediatric CICUs have evolved, with a greater emphasis on concerning trends (CT).
- These communications facilitate early interventions, potentially reducing the incidence of cardiac arrest (CA).
- This TCC model shows promise for improving patient safety in pediatric cardiac critical care.
Abstract:
Introduction: Despite advances in treatment of children with critical heart disease, cardiac arrest (CA) remains a common occurrence. We provided virtual support to bedside teams (BTs) from a tele-critical care (TCC) unit in a pediatric cardiac intensive care unit (CICU) and focused on early detection of concerning trends (CT) and avoidance of CA. Virtual surveillance workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. We present our initial experience with a focus on critical communications (CCs) to BTs. Methods: A retrospective, descriptive review of TCC activities was conducted from January 2019 to December 2022, involving electronic databases and electronic medical records of patients in the CICU, including related CCs to BTs, responses from BTs, and related CA. Results: We conducted 18,171 TCC activities, including 2,678 non-CCs and 248 CCs. Over time, there was a significant increase in the proportion of CCs related with CT (p = 0.002), respiratory concerns (<0.001), and abnormalities in cardiac rhythm (p = 0.04). Among a sample of 244 CCs, subsequent interventions by BTs resulted in adjustment of medical treatment (127), respiratory support (68), surgery or intervention (19), cardiac rhythm control (17), imaging study (14), early resuscitation (9), and others (10). Conclusions: CCs from a TCC unit in a pediatric CICU changed over time with an increased focus on CT and resulted in early interventions, potentially contributing to avoiding CA. This model of care in pediatric cardiac critical care has the potential to improve patient safety.
