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Feasibility and acceptability of pediatric expert teleconsultation during critical ambulance transports: a pilot
Tehnaz P Boyle1, Derrick Chu1,2, Ijeoma M Okafor3
1Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
Background:
Before a trial testing prehospital teleconsultation for children, we studied acceptability, feasibility, and workload after integrating teleconsultation into Emergency Medical Service (EMS) workflows.
Methods:
We randomized paramedic-physician teams to teleconsultation (audio/video call, intervention) or usual care (audio call, control) for three simulated pediatric transports using mixed methods. Paramedic dyads provided in-ambulance simulated care while remote pediatric emergency physicians offered real-time consultation. In the intervention group, we used the Telehealth Usability Questionnaire to measure acceptability [primary; Total Usability Score (TUS), maximum = 7] and feasibility [secondary; Interaction Quality Score (IQS)]; and interviews for Technology Acceptance Model themes. Between groups, we calculated descriptive statistics and compared connection success and workload.
Results:
Twenty-four teams (12/group) completed 72 simulated transports. Intervention paramedics attempted physician contact in 94% (34/36) of transports versus 47% (17/36) in control; 92% connected in ≤2 attempts. In the intervention group, mean TUS was 5.6 (95% CI 5.2, 6.0) for physicians and 5.8 (95% CI 5.5, 6.0) for paramedics; mean IQS was 5.2 (95% CI 4.6, 6.0) and 5.9 (95% CI 5.4, 6.3) respectively. Intervention paramedics reported similar workload to controls (p = 0.26) but less frustration (p = 0.03); physicians experienced higher workload (p = 0.01). Interviews identified improved communication and physician involvement, alongside uncertainty about physician roles and impact on paramedic autonomy. Video quality was adequate, but concerns about real-world audio and broadband reliability remained.
Conclusions:
In simulations, teleconsultation for pediatric EMS transports was acceptable and feasible with minor technical modifications. Implementation should balance physician workload and clarify roles through training. Future trials should evaluate patient outcomes.
