Friday, August 27, 2010

Instant care for the smallest, sickest patients

Connected care: Noviski with a portable telemedicine station in the PICU

Imagine it's the middle of the night, and a resident in the Pediatric Intensive Care Unit (PICU) needs to consult with the attending physician on call about a patient. The child'

s parent is worried and waits nervously for the two physicians to connect. In the past, overnight and weekend on-call attending physicians in the PICU were contacted by telephone by the covering fellow or resident. Patients and families had to wait while the attending physician provided guidance and decided whether it was necessary to come into the hospital -- without input from the rest of the team or personally seeing the patient.

Through a new, pioneering program, MassGeneral Hospital for Children (MGHfC) is improving care and reducing these wait times by enabling instant communication and assessment via telemedicine. The program, Connected Pediatric Critical Care, features real-time video communication that allows the on-call attending physician to examine the patient from home and communicate directly with the PICU staff, other specialists and the child's parents. Special cameras and scopes can be attached to the hospital-based unit to allow for closer evaluation of the patient.

Says Natan Noviski, MD, chief of Pediatric Critical Care Medicine at MGHfC, "Since launching this program in May, we are already seeing that the Connected Pediatric Critical Care program significantly improves 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."

In one recent case, an 11-year-old girl was admitted to the PICU at 2 am with respiratory distress. Without having to travel back to the hospital, the on-call attending physician was able to evaluate the patient on video, diagnose respiratory failure and discuss treatment with the nurse, PICU fellow and respiratory therapist at the patient's bedside. The on-call attending also was able to address the mother's concerns and supervise the patient's treatment.

"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," says Joseph C. Kvedar, MD, an MGH dermatologist and director of the Partners Center for Connected Health -- a program that combines remote-monitoring technology, sensors and online communications to improve patient adherence, engagement and clinical outcomes. "We anticipate that other intensive care units, for both adult and pediatric patients, could benefit as well."

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