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Miller N, Catherall D, Pompa AG, Roelle L, Conner T, Orr WB, Avari Silva JN. Use of digital health technologies in periprocedural pediatric cardiac ablation. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:173-177. [PMID: 38989043 PMCID: PMC11232418 DOI: 10.1016/j.cvdhj.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Affiliation(s)
- Nathan Miller
- Electrophysiology Laboratory, St. Louis Children's Hospital, St. Louis, Missouri
| | - David Catherall
- Washington University School of Medicine, St. Louis, Missouri
| | - Anthony G Pompa
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Lisa Roelle
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Tracy Conner
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - William B Orr
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
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Mikulski MF, Well A, Shmorhun D, Mery CM, Fenrich AL, Fraser CD. Impact of electrophysiologists at daily multidisciplinary report in a paediatric cardiac care unit. Cardiol Young 2024:1-7. [PMID: 38577782 DOI: 10.1017/s1047951124000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report. METHODS This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations. RESULTS Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1-4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician's interpretation of rhythm or electrocardiogram. CONCLUSION Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Daniel Shmorhun
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Arnold L Fenrich
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Vaughan RM, Moore JA, Moreno JS, Dyer KJ, Oluyomi AO, Lopez KN. Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era. Pediatr Cardiol 2023; 44:404-412. [PMID: 36562781 PMCID: PMC9786515 DOI: 10.1007/s00246-022-03042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10-17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.
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Affiliation(s)
- Ruth M. Vaughan
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Judson A. Moore
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA ,Department of Pediatrics, Section of Cardiology, Primary Children’s Hospital, Salt Lake City, UT USA
| | - Jasmine S. Moreno
- Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Karla J. Dyer
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX USA ,Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Keila N. Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
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Preminger TJ. Telemedicine in pediatric cardiology: pros and cons. Curr Opin Pediatr 2022; 34:484-490. [PMID: 35983842 DOI: 10.1097/mop.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review recent uses of telemedicine in pediatric cardiology, highlighting merits, challenges, and future directions. RECENT FINDINGS The COVID-19 pandemic accelerated telemedicine use, which has had a positive impact with respect to providers, patients, and their caregivers. Recent data have demonstrated the feasibility and effectiveness of telemedicine through expediting needed care and reducing healthcare utilization, including unnecessary emergency department visits, transports, and hospitalizations. With increasing complexity of cardiac care, telecardiology allows for establishing a medical home, improving access, and continuity of care. Great potential also exists for telecardiology to permit more consistent preventive care, possibly resulting in improved health equity, reduced morbidity and mortality, and associated costs. Challenges to optimal implementation of telecardiology, which are all surmountable, include the currently unaccounted additional workload and administrative burden, licensing restrictions, disparities in access to care, insurance reimbursement, and potential fraud and abuse. SUMMARY Telecardiology allows for efficient, quality, effective, collaborative care and is foundational to creating innovative, high-value care models. Through integration with accelerating technology and in-person visits, a sustainable hybrid model of optimal care can be achieved. Addressing barriers to progress in telecardiology is critical.
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Affiliation(s)
- Tamar J Preminger
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Roelle L, Ocasio J, Littell L, Fredman E, Miller N, Conner T, Van Hare G, Avari Silva JN. Expanding telehealth through technology: Use of digital health technologies during pediatric electrophysiology telehealth visits. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:256-261. [PMID: 35965632 PMCID: PMC9363236 DOI: 10.1016/j.cvdhj.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lisa Roelle
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Juliana Ocasio
- School of Arts and Sciences, Washington University in St. Louis, St. Louis, Missouri
| | | | - Eli Fredman
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tracy Conner
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - George Van Hare
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer N. Avari Silva
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Address reprint requests and correspondence: Dr Jennifer N. Avari Silva, Division of Pediatric Cardiology, 1 Children’s Place, CB 8116 NWT, Saint Louis, MO 63110.
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