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de Oliveira Laguna Silva G, König Klever E, Castro da Rocha J, da Silva MMD, da Rosa de Amorim J, Cristina Jacovas V, Marina Simionato B, Gomes da Cunha L, Zaupa APB, Mafalda Krauzer JR, de Almeida Pires A, Cezar Cabral F, de Campos Moreira T, Rodrigues Moleda Constant HM. Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial. Postgrad Med 2024:1-8. [PMID: 39093639 DOI: 10.1080/00325481.2024.2388023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). METHODS An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. RESULTS A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. CONCLUSION Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT05260710 and ReBEC - RBR-7×j4wyp.
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Azzolini C, Premi E, Donati S, Falco A, Torreggiani A, Sicurello F, Baj A, Azzi L, Orro A, Porta G, Azzolini G, Sorrentino M, Melillo P, Testa F, Simonelli F, Giardina G, Paolucci U. Ten Years of Experience With a Telemedicine Platform Dedicated to Health Care Personnel: Implementation Report. JMIR Med Inform 2024; 12:e42847. [PMID: 38277199 PMCID: PMC10858419 DOI: 10.2196/42847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/13/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Telemedicine, a term that encompasses several applications and tasks, generally involves the remote management and treatment of patients by physicians. It is known as transversal telemedicine when practiced among health care professionals (HCPs). OBJECTIVE We describe the experience of implementing our telemedicine Eumeda platform for HCPs over the last 10 years. METHODS A web-based informatics platform was developed that had continuously updated hypertext created using advanced technology and the following features: security, data insertion, dedicated software for image analysis, and the ability to export data for statistical surveys. Customizable files called "modules" were designed and built for different fields of medicine, mainly in the ophthalmology subspecialty. Each module was used by HCPs with different authorization profiles. IMPLEMENTATION (RESULTS) Twelve representative modules for different projects are presented in this manuscript. These modules evolved over time, with varying degrees of interconnectivity, including the participation of a number of centers in 19 cities across Italy. The number of HCP operators involved in each single module ranged from 6 to 114 (average 21.8, SD 28.5). Data related to 2574 participants were inserted across all the modules. The average percentage of completed text/image fields in the 12 modules was 65.7%. All modules were evaluated in terms of access, acceptability, and medical efficacy. In their final evaluation, the participants judged the modules to be useful and efficient for clinical use. CONCLUSIONS Our results demonstrate the usefulness of the telemedicine platform for HCPs in terms of improved knowledge in medicine, patient care, scientific research, teaching, and the choice of therapies. It would be useful to start similar projects across various health care fields, considering that in the near future medicine as we know it will completely change.
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Affiliation(s)
- Claudio Azzolini
- Advisory Council of e-Health and Telemedicine, University of Insubria of Varese-Como, Varese, Italy
- TM95 Srl, Milan, Italy
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
| | - Elias Premi
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Department of Life Sciences and Biotechnologies, University of Insubria, Varese-Como, Italy
| | - Simone Donati
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Andrea Falco
- TM95 Srl, Milan, Italy
- Alfa Design Studio, Milan, Italy
| | | | - Francesco Sicurello
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Lorenzo Azzi
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | - Alessandro Orro
- TM95 Srl, Milan, Italy
- Italian Association of Telemedicine and Medical Informatics, Milan, Italy
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Giovanni Porta
- Department of Medicine and Surgery, University of Insubria, Varese-Como, Italy
| | | | | | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Testa
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Griggs AC, Fausett CM, Simonson RJ, Williams KN, Bisbey TM, Lazzara EH, Keebler JR, DiazGranados D, Mishra VK, Thomas EJ, Salas E. Telerounding: A scoping review and implications for future healthcare practice. HUMAN FACTORS IN HEALTHCARE 2021; 1:100008. [PMID: 35983374 PMCID: PMC9384964 DOI: 10.1016/j.hfh.2022.100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review. METHOD We collected articles from nine scientific databases from the earliest dated available articles to August 2020. We identified whether each article centered on telerounding policies, regulations, or practice. We also organized information from each article and sorted themes into four categories: sample characteristics, technology utilized, study constructs, and research outcomes. RESULTS We identified 21 articles related to telerounding that fit our criteria. All articles emphasized telerounding practice. Most articles reported data collected from surgical wards, had adult samples, and utilized robotic telerounding systems. Most articles reported null effects or positive effects on their measured variables. DISCUSSION Providers and patients can benefit from the effective implementation of telerounding. Telerounding can support patient care by reducing travel expenses and opportunities for infection. Evidence suggests that telerounding can reduce patient length of stay. Patients and providers are willing to utilize telerounding, but patient willingness is influenced by age and education. Telerounding does not appear to negatively impact satisfaction or patient care. Organizations seeking to implement telerounding systems must consider education for their providers, logistics associated with hardware and software, scheduling, and characteristics of the organizational context that can support telerounding. Considerations provided in this article can mitigate difficulties associated with the implementation of telerounding.
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Affiliation(s)
- Andrew C Griggs
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Crystal M Fausett
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Richard J Simonson
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Kimberly N Williams
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Tiffany M Bisbey
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | | | - Vimal K Mishra
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric J Thomas
- Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Eduardo Salas
- Department Chair, Department of Psychological Sciences, Rice University, Houston, TX, USA
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Telemedicine in Pediatric Intensive Care Units: Perspectives From a Brazilian Experience. CURRENT PEDIATRICS REPORTS 2021; 9:65-71. [PMID: 34277142 PMCID: PMC8274668 DOI: 10.1007/s40124-021-00242-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review To present the implementation of a telemedicine project (TeleICU) in pediatric intensive care units (ICU) throughout different Brazilian regions. Recent Findings Although telemedicine in pediatric ICUs has shown evidence of benefit in numerous studies with potential to 18 mitigate existing disparities, in Brazil, its use is still under development. Brazil has several opportunities for implementing this resource since, according to the National Registry of Healthcare 20 Establishments (NRHE), there is a discrepancy in the density of pediatric intensive care physicians per patient and the availability 21 of pediatric ICU beds per number of inhabitants. Summary Health technologies are being widely used to fill gaps in the healthcare system. Telemedicine has been an important tool to meet demands in intensive care units, especially the demand for specialized assistance. TeleICU is a Brazilian model of telemedicine that performs multidisciplinary telerounds in remote pediatric ICUs and develops continuing education activities for the healthcare teams. The project aims to systematize and to qualify care, as well as to reduce risks for patients admitted to pediatric ICUs engaged in the project. Preliminary results have demonstrated a positive impact regarding this approach, providing medical care to 6640 inpatients-day in two Brazilian pediatric ICUs, for 616 patients during 946 daily telerounds. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-021-00242-z.
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Vinadé Chagas ME, Rodrigues Moleda Constant HM, Cristina Jacovas V, Castro da Rocha J, Galves Crivella Steimetz C, Cotta Matte MC, de Campos Moreira T, Cezar Cabral F. The use of telemedicine in the PICU: A systematic review and meta-analysis. PLoS One 2021; 16:e0252409. [PMID: 34048494 PMCID: PMC8162650 DOI: 10.1371/journal.pone.0252409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.
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Affiliation(s)
- Maria Eulália Vinadé Chagas
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
- * E-mail:
| | | | - Vanessa Cristina Jacovas
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Jacqueline Castro da Rocha
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Carina Galves Crivella Steimetz
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Maria Cristina Cotta Matte
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Taís de Campos Moreira
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Felipe Cezar Cabral
- Brazilian Unified Health System Institutional Development Program (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
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Huffman LC, Feldman HM, Hubner LM. Fellows Front and Center: Tele-Training and Telehealth. Acad Pediatr 2020; 20:764-765. [PMID: 32574764 PMCID: PMC7305879 DOI: 10.1016/j.acap.2020.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Lynne C Huffman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Lauren M Hubner
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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