Remote Pediatric Critical Care Telephone Consultations: Quality and Outcomes

Janice A. Tijssen; Michael R. Miller; Christopher S. Parshuram

doi:10.1055/s-0039-1679900

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2019; 08(03): 148-155
DOI: 10.1055/s-0039-1679900

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Remote Pediatric Critical Care Telephone Consultations: Quality and Outcomes

Janice A. Tijssen

¹Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada

²Children's Health Research Institute, London, Ontario, Canada

,

Michael R. Miller

¹Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada

²Children's Health Research Institute, London, Ontario, Canada

,

Christopher S. Parshuram

³Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

⁴Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

⁵Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada

⁶The Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada

› Author Affiliations

Abstract

There are no studies describing the nature and quality of telephone consultations for critically ill children despite being an important part of pediatric intensive care. We described pediatric telephone consultations to a PICU in Ontario, Canada in 2011 and 2012. Of 203 consultations, 104 patients (51.2%) were admitted to the PICU; this was associated with weekend consultations (p = 0.005) and referral hospital location (p = 0.036). Frequency of interruptions was 1 in every 3.2 (2.0, 5.7) minutes and not associated with call content. Twenty-one percent of consults had limited discussion of vital signs. Our study described our center's remote critical care consultation program and outcomes.

Keywords

pediatric critical care - remote consultation - quality

Full Text

References

References
1 Holmes MJ, Reyes HM. A critical review of urban pediatric trauma. J Trauma 1984; 24 (03) 253-255
2 Pracht EE, Tepas III JJ, Langland-Orban B, Simpson L, Pieper P, Flint LM. Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?. J Pediatr Surg 2008; 43 (01) 212-221
3 Newgard CD, McConnell KJ, Hedges JR, Mullins RJ. The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments. J Trauma 2007; 63 (05) 965-971
4 Pollack MM, Alexander SR, Clarke N, Ruttimann UE, Tesselaar HM, Bachulis AC. Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med 1991; 19 (02) 150-159
5 Pearson G, Shann F, Barry P. , et al. Should paediatric intensive care be centralised? Trent versus Victoria. Lancet 1997; 349 (9060): 1213-1217
6 CritiCall O. Available at: https://www.phrs.criticall.org/User/LogIn?ReturnUrl=%2f
7 Wadhwa A, Lingard L. A qualitative study examining tensions in interdoctor telephone consultations. Med Educ 2006; 40 (08) 759-767
8 Cartmill M, White BD. Telephone advice for neurosurgical referrals. Who assumes duty of care?. Br J Neurosurg 2001; 15 (06) 453-455
9 Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH. Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med 2001; 38 (02) 146-151
10 Gladstone J. Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. J Adv Nurs 1995; 22 (04) 628-637
11 Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ 1989; 298 (6670): 366-370
12 Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med 2004; 79 (02) 186-194
13 Rabøl LI, Andersen ML, Østergaard D, Bjørn B, Lilja B, Mogensen T. Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals. BMJ Qual Saf 2011; 20 (03) 268-274
14 Manias E, Geddes F, Watson B, Jones D, Della P. Communication failures during clinical handovers lead to a poor patient outcome: lessons from a case report. SAGE Open Med Case Rep 2015; 3: X15584859
15 Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in U.S. hospitals. J Healthc Manag 2010; 55 (04) 265-281 , discussion 281–282
16 Chapman SM, Wray J, Oulton K, Pagel C, Ray S, Peters MJ. ‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems. Arch Dis Child 2017; 102 (06) 487-495
17 Parshuram CS, Dryden-Palmer K, Farrell C. , et al. Canadian critical care trials G and the EI. Effect of a pediatric early warning system on all-cause mortality in hospitalized pediatric patients: the EPOCH randomized clinical trial. JAMA 2018; 319 (10) 1002-1012
18 Gregory CJ, Nasrollahzadeh F, Dharmar M, Parsapour K, Marcin JP. Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions. Pediatrics 2008; 121 (04) e906-e911
19 Hixson ED, Davis S, Morris S, Harrison AM. Do weekends or evenings matter in a pediatric intensive care unit?. Pediatr Crit Care Med 2005; 6 (05) 523-530
20 Dayal P, Hojman NM, Kissee JL. , et al. Impact of telemedicine on severity of illness and outcomes among children transferred from referring emergency departments to a children's hospital PICU. Pediatr Crit Care Med 2016; 17 (06) 516-521
21 Dharmar M, Romano PS, Kuppermann N. , et al. Impact of critical care telemedicine consultations on children in rural emergency departments. Crit Care Med 2013; 41 (10) 2388-2395
22 Heath B, Salerno R, Hopkins A, Hertzig J, Caputo M. Pediatric critical care telemedicine in rural underserved emergency departments. Pediatr Crit Care Med 2009; 10 (05) 588-591
23 Guide to Enhancing Referrals and Consultations Between Physicians. Royal College of Physicians and Surgeons of Canada with The College of Family Physicians of Canada; 2009. Available at: https://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=3448 . Accessed November 2018
24 Chang YC, Ng CJ, Wu CT, Chen LC, Chen JC, Hsu KH. Pediatric overtriage as a consequence of the tachycardia responses of children upon ED admission. Am J Emerg Med 2015; 33 (01) 1-6
25 Chang YC, Ng CJ, Wu CT, Chen LC, Chen JC, Hsu KH. Effectiveness of a five-level Paediatric Triage System: an analysis of resource utilisation in the emergency department in Taiwan. Emerg Med J 2013; 30 (09) 735-739
26 Bianchi W, Dugas AF, Hsieh YH. , et al. Revitalizing a vital sign: improving detection of tachypnea at primary triage. Ann Emerg Med 2013; 61 (01) 37-43
27 Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care 2003; 48 (04) 386-396 , discussion 397–398
28 Fleming S, Thompson M, Stevens R. , et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377 (9770): 1011-1018
29 van Veen M, Steyerberg EW, Ruige M. , et al. Manchester triage system in paediatric emergency care: prospective observational study. BMJ 2008; 337: a1501
30 Seiger N, van Veen M, Steyerberg EW, van der Lei J, Moll HA. Accuracy of triage for children with chronic illness and infectious symptoms. Pediatrics 2013; 132 (06) e1602-e1608
31 Tijssen JA, To T, Morrison LJ. , et al. Paediatric health care access in community health centres is associated with survival for critically ill children who undergo inter-facility transport: a province-wide observational study. Paediatr Child Health 2019. doi: 10.1093/pch/pxz013

Supplementary Material

Supplementary Material