9 ) Will Using Telemedicine with Medical Command during Situational Awareness Escalation Add Value to Patient Care ?
Kathy Farrell , MD , FAAP , Brad Bishop , MD , FAAP Medicine Program at CMH-Kansas ; Lisa Carney MD , FAAP , Laura Fitzmaurice MD , FAAP , FACEP , Matthew Johnson MD , FAAP , Natalie Masters , MSN , RN , Sherry McCool , Lisa Pruitt , BSN , RN , C-NPT
Children ’ s Mercy Hospital Kansas City
Background : Critically ill patients arrive or deteriorate during admission at remote Children ’ s Mercy Kansas Hospital ( CMK ). The most common reason for transfer is respiratory distress . Transfers are initiated with a conference call with an intensivist ( NICU / PICU ), a Transport Shift Coordinator ( TSC with PICU RN / RT expertise ), Bed Control , and a CMK Hospitalist . The TSC listens to the phone call to triage / dispatch the appropriate critical care transport team accordingly . Phone triage and handoff do not allow a visual clinical assessment . Telemedicine is a tool to improve communication and offer a visual clinical assessment at the bedside readily . A telemedicine workflow has been developed when there is a delay in transfer 17.5 miles between campuses from CMK to Adele Hall , Children ’ s Mercy Kansas City .
Methods : Telemedicine offers video “ eyes ” and USB stethoscope “ ears ” to assess patient status , triage the appropriate transport team , and offer support with critical care interventions . Telemedicine can be requested by a CMK Hospitalist for many reasons , including a delay in transport team availability , or high patient acuity requiring multiple safety huddles . Situational Awareness ( SA ) safety huddles had previously been developed to successfully reduce Code Blue occurrence at CMK .
Measure Outcome : Total # of SA safety huddles at CMK / Total # of SA patients at CMK Transferred , Total # SA Huddles using Telemedicine / Total # SA patients transferred using telemedicine .
Process Measure : Continue to identify high-risk patients via SA Huddle for patients with Pediatric Early Warning Score ( PEWS ) >= 5 , High flow Nasal Cannula initiation , or cardiac PEW >= 4 .
Conclusion : Telemedicine helps triage and communicate the most appropriate level of transport team ( critical vs . noncritical ) when patients are determined to need escalation and transfer of care . Telemedicine offers PICU expertise , a visual clinical assessment and early intervention when caring for clinically deteriorating patients .
10 ) Diagnosing from a Distance and Treating Locally : Results of a Combined MFM / Fetal Cardiac Telehealth Program
Gerard Frunzi , MBA 1 , Bettina F . Cuneo MD 2 , Amy Gagnon , MD 3 , Nicholas Behrendt 4 , J . Fred Thomas PhD 1 , 5 , Christina A . Olson MD 1 , 5 Justin Linder 1
1
Telehealth Department , Children ’ s Hospital Colorado , 2 Department of Pediatrics , Division of Cardiology , the Colorado Fetal Care Center , University of Colorado School of Medicine , 3 St . Mary ’ s Medical Center , 4 Department of Obstetrics and Gynecology , Division of Maternal Fetal Medicine , The Colorado Fetal Care Center , University of Colorado School of Medicine ; 5 Department of Pediatrics , University of Colorado School of Medicine
Background : Congenital heart disease ( CHD ) is the most common and most lethal congenital anomaly . Prenatal diagnosis of fetal CHD improves postnatal outcomes , especially with a focus on the maternal / fetal dyad . By identifying , monitoring and treating conditions that increase the risk for adverse outcomes , a team of maternal fetal medicine ( MFM ) and fetal cardiology physicians can risk stratify pregnancies and provide anticipatory care . A barrier to improved care recognizing this approach is limited subspecialty care in sparsely populated regions .
Methods : We reviewed the feasibility , outcomes and local provider / patient acceptance of an MFM / fetal cardiology virtual clinic between an MFM practice on the Western slope with a catchment area of ~ 900 square miles , and the Colorado Fetal Care Center ( CFCC ), 250 miles away . The two sites were connected by HIPPA compliant video conferencing software in conjunction with live-stream ultrasound equipment using broad band internet . Onsite technical expertise was available at both centers . The CFCC physician would obtain a history from the patient , view the ultrasound or fetal echo live , then discuss the results with the family . The local physician and the CFCC physician jointly decided the management plan , which emphasized local patient care . Following the encounter , the patient filled out a survey of their experience .
Results : In the 18 months since the cardiology virtual clinic ’ s inception , 437 patient visits / fetal echoes have occurred with fewer than 10 having to be repeated at another clinic time for technical failures . All abnormal patients traveled to Denver for delivery , but were followed locally until delivery . One mother refused telemedicine services . All other mothers preferred telemedicine services locally over traveling to in-person services at the CFCC . The program continues to grow . MFM telehealth services started in January 2018 and 169 CFCC MFM encounters have occurred to date . This Cardiology clinic allows Pediatric / Fetal Cardiologists to see patients that would otherwise have to travel 250 miles . The MFM telehealth offering allows a solo MFM provider to have virtual partners that function like a normal clinic . Currently , ~ 44 MFM / fetal cardiology visits are scheduled per week .
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