Abstract
Background In rural areas in Germany, the number of emergency departments
with pediatric expertise decreases. Telemedicine solutions are used
sporadically, but they lack certain parameters for assessing a child's
health status, such as touch and smell. We tested and evaluated the
implementation of a telemedical, cross-hospital urgency assessment in pediatric
emergency rooms. The telemedical urgency assessments were carried out via video
conferences and were compared to the usual on-site procedure. Primary results of
the concordance analysis have been published elsewhere. This work describes the
results of the evaluation of the implementation.
Methods The telemedical urgency assessment was carried out in 5 pediatric
emergency departments during the years 2015-2019. Various methods were used to
evaluate the implementation. The following reports are based on (a) a parent
questionnaire with two statements to be evaluated (entire project duration), (b)
a survey of the physicians using telemedicine after each case (entire project
duration) and (c) detailed process documentation (July 2017 until end of the
project).
Results A total of 266 patients under 18 years old, recruited from four
hospitals, were included in the study. (a) 210 parents completed the
questionnaire. 78% of the parents felt adequately cared for and 70% could
imagine telemedicine becoming established as a future supplementary care
procedure. (b) The physicians' questionnaires for the telemedicine site
were completed in 232 cases (87%). The average satisfaction rating was 1.8 on a
6-point-likert-scale (95% confidence interval: 1.64; 1.95). (c) The most
frequent implementation problem concerned the technical implementation of the
video conference. The evaluation of the accompanying documentation revealed in
particular implementation barriers in the technical area (e. g. limited video
and/or audio quality) and in the provision of human resources.
Conclusion Despite implementation barriers, the project showed that
telemedical urgency assessment in acute pediatric care is a promising option for
supporting care. Most of the participating clinicians needed a high level of
support, which in some cases indicated a rather low level of digital competence.
Increasing acceptance of telemedicine functionalities requires changes in
society as a whole with improved framework conditions.
Keywords
telemedicine - acute pediatrics - primary care - rural regions - triage
