Pediatric Telemedicine Use in United States Emergency Departments
Pediatric Telemedicine Use in United States Emergency Departments
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DOI：
10.1111/acem.13629
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发表时间：
2018-12-01
影响因子：
4.4
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
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作者：
Brova, Monica;Boggs, Krislyn M.;Camargo, Carlos A., Jr.
通过电信（儿科远程医疗）接收儿童的远程临床护理似乎可以改善美国急诊科（ED）的医疗服务和质量，但儿科远程医疗接收的实际流行程度和特征仍不清楚。我们确定了美国急诊科儿科远程医疗的流行程度和当前应用，重点是从其他机构的临床医生那里接受远程医疗的急诊科。我们调查了所有5，375名美国急诊科医生，以描述2016年的急诊护理。然后，我们随机调查了337名报告接受儿科远程医疗的ED中的130名（39%）。第二次调查主要是通过电话对艾德董事进行的。它证实，艾德在2017年接受了儿科远程医疗服务，并询问了艾德的人员配备以及儿科远程医疗实施的性质、目的和问题。结果第一次调查（4，507/5，375，84%的响应）显示，337（8%）ED报告接受儿科远程医疗。在完成第二次调查的随机抽样ED中（107/130，82%的回复），96（90%）确认2016年使用，89（83%）确认2017年使用。中止的原因包括技术和时间安排方面的问题。几乎所有在2017年确认其儿科远程医疗使用的人也报告了24/7可用性（98%）。报告最多的用途是患者放置和转移协调（80%）。许多ED（39%）报告说，实施儿科远程医疗没有挑战，并描述了其效用。然而，最常报告的挑战是流程问题（30%），例如对减慢或中断提供商工作流程的担忧以及技术问题（14%）。结论：全国范围内，很少有急诊科医生接受远程医疗提供儿科急诊护理。在使用远程医疗进行儿科护理的ED中，许多人报告了过程问题。通过有针对性的教育或干预措施来解决这些障碍，可以支持ED进一步开发和优化儿科急诊护理的技术辅助手段。
Introduction The receipt of remote clinical care for children via telecommunications (pediatric telemedicine) appears to improve access to and quality of care in U.S. emergency departments (EDs), but the actual prevalence and characteristics of pediatric telemedicine receipt remain unclear. We determined the prevalence and current applications of pediatric telemedicine in U.S. EDs, focusing on EDs that received telemedicine from clinicians at other facilities. Methods We surveyed all 5,375 U.S. EDs to characterize emergency care in 2016. We then randomly surveyed 130 (39%) of the 337 EDs who reported receiving pediatric telemedicine. The second survey was administered by phone to ED directors primarily. It confirmed that the ED received pediatric telemedicine services in 2017 and asked about ED staffing and the nature, purpose, and concerns with pediatric telemedicine implementation. Results The first survey (4,507/5,375, 84% response) showed that 337 (8%) EDs reported receiving pediatric telemedicine. Among the randomly sampled EDs completing the second survey (107/130, 82% response), 96 (90%) confirmed 2016 use and 89 (83%) confirmed 2017 use. Reasons for discontinuation included technical and scheduling concerns. Almost all who confirmed their pediatric telemedicine use in 2017 also reported 24/7 availability (98%). The most widely reported use was for patient placement and transfer coordination (80%). Many EDs (39%) reported no challenges with implementing pediatric telemedicine and described its utility. However, the most frequently reported challenges were process concerns (30%), such as concerns about slowing or interrupting providers' work flow and technological concerns (14%). Conclusion Few EDs receive telemedicine for the delivery of pediatric emergency care nationally. Among EDs that do use telemedicine for pediatric care, many report process concerns. Addressing these barriers through focused education or interventions may support EDs in further developing and optimizing this technological adjunct to pediatric emergency care.