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Sunday, February 28, 2010
Young patients being treated in the Pediatric Intensive Care Unit (PICU) at MassGeneral Hospital for Children (MGHfC) often require ongoing and around-the-clock assessment and care management, coordinated among a team of residents, fellows, nurses, respiratory therapists and attending physicians. A new, pioneering home-to-hospital program, Connected Pediatric Critical Care, features real-time video communication, enabling the on-call attending physician, when at home, to personally examine the patient and communicate directly with the PICU staff, other specialists and even the child’s parents. Six PICU physicians from MGHfC now have videoconferencing units in their homes. When they are needed for a consult in the middle of the night or on weekends, they videoconference in from home, to a portable telemedicine station positioned at the patient’s bedside. The attending physician can then see the patient, talk with clinicians on-site, personally evaluate the child’s condition and make treatment decisions. Special cameras and scopes can also be attached to the hospital-based unit to allow for closer evaluation of the young patient.
At the Patient’s Bedside, No Treatment Delay
In one recent case, an 11-year-old girl was admitted to the PICU at 2 am, with respiratory distress. From home, the on-call attending physician was able to evaluate the patient on video, identify the respiratory failure and discuss treatment with the nurse, PICU fellow and respiratory therapist at the patient’s bedside. The on-call attending physician was also able to address the mother’s concerns and supervise the patient’s treatment, without having to wait for the on-call attending physician to travel back to the hospital. “Since launching this program in May, we are already seeing that the Connected Pediatric Critical Care program is significantly improving the quality of care, team communication and staff responsiveness during evening hours and weekends when our attending physicians, ultimately responsible for patient care, have left the hospital to go home,” said Natan Noviski, MD, chief, Pediatric Critical Care Medicine, MassGeneral Hospital for Children. “Because the attending physician can remotely examine the patient and communicate with the on-site staff directly, decision making can be enhanced and the quality of care improved.” Overnight and weekends, on-call attending physicians were traditionally contacted via telephone by the covering fellow or resident in the PICU. The attending physician would provide guidance, via telephone, without input from the rest of the team and without personally seeing the patient. The attending would then decide if it was necessary to return to the hospital. “Videoconferencing is not new, but the application of this technology – connecting at-home physicians with their patients and the hospital-based medical team – is a novel and important advance in critical care medicine,” added Joseph C. Kvedar, MD, director, Center for Connected Health. “We anticipate that other intensive care units, for both adult and pediatric patients, could benefit as well.” The Connected Pediatric Critical Care program also creates a more robust teaching opportunity, allowing residents to be more involved in the team approach essential in an intensive care environment. Importantly, parents also feel more confident in their child’s care and more connected to the treating physician, giving parents the opportunity to interact directly with the attending doctor at home. According to a study published in Pediatrics (1998; 102 (5); e58), the use of connected health to assess sick children has been shown to have both a high sensitivity (ability of the remote physician to detect abnormal findings) and a high specificity (ability of the remote physician to detect normal findings). For example, the observations of a remote pediatric critical care medicine physician matched those made by a pediatric emergency room physician 97% of the time. Assessment of physical signs requiring direct visualization, such as neurological status, made by the remote physician and the on-site emergency room doctor, were the same in 100% of the cases.
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