Nighttime telecommunication between remote staff intensivists and bedside personnel in a pediatric intensive care unit: a retrospective study

Abstract

Objective: To investigate the hypothesis that nighttime telemedicine can help staff intensivists remotely manage patients in a pediatric intensive care unit, preserve continuity of care, communicate with the bedside team, and provide reassurance to families in a unit where fellows provide nighttime, onsite care, with supervision by staff intensivists available by pager.

Design: A retrospective review.

Setting: A pediatric intensive care unit in an academic, tertiary medical center with telemedicine capability, including a mobile telemedicine cart in the pediatric intensive care unit and a home-based unit for each pediatric staff intensivist.

Patients: Critically ill pediatric patients between 0 and 19 yrs, who were admitted to the pediatric intensive care unit between May 2010 and July 2011 and were managed via telemedicine.

Interventions: Consecutive intake forms completed by staff intensivists following each telemedicine encounter were reviewed.

Main results: Fifty-six consecutive intake forms were evaluated for the study period. Connectivity was established in 95% of attempts. Audio and video qualities were excellent 94% and 85% of the time, respectively. The median call duration was 15 mins. The pediatric critical care fellow was present for 100% of calls, nurses 68%, and parents 66%. Reasons for initiating the call were "patient assessment" (98%), "team meeting" (25%), and/or parent update (40%). "Patient assessment," "communication with multidisciplinary care team," and "communication with a patient's family" were the outcomes most often cited that would not have been possible via telephone. A change in medical management was noted following 32% of encounters.

Conclusions: This study demonstrates that nighttime telecommunication linking staff intensivists on home-call with pediatric intensive care unit bedside care providers, patients, and their families is technologically feasible and may enhance team communication, provide reassurance to families, and impact patient management.