Pediatric Tele-Critical Care: Initial Experience with a Continuous Surveillance Model Aiming to Prevent Cardiac Arrest in Children with Critical Heart Disease

Authors

Alejandro Lopez Magallon, Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.
Lucas Saenz, Telemedicine Program, Children's National Hospital, Washington, District of Columbia, USA.
Rittal Mehta, Division of Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia, USA.
Maria Angelica Chacón, Department of Pediatrics, Children's National Hospital, the George Washington University School of Medicine, Washington, District of Columbia, USA.
Santiago Martinez Ransanz, Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.
Kellie Swink, Telemedicine Program, Children's National Hospital, Washington, District of Columbia, USA.
Menchee Berris, Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.
Sofia Hanabergh, Division of Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia, USA.
Can Yerebakan, Division of Cardiovascular Surgery, Children's National Hospital, Washington, District of Columbia, USA.
David Wessel, Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.
Ricardo Munoz, Division of Cardiac Critical Care, Children's National Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

6-28-2024

Journal

Telemedicine journal and e-health : the official journal of the American Telemedicine Association

DOI

10.1089/tmj.2024.0035

Keywords

cardiac arrest; congenital heart defects; patient safety; remote monitoring; tele-critical care; telemedicine

Abstract

Despite advances in treatment of children with critical heart disease, cardiac arrest (CA) remains a common occurrence. We provided virtual support to bedside teams (BTs) from a tele-critical care (TCC) unit in a pediatric cardiac intensive care unit (CICU) and focused on early detection of concerning trends (CT) and avoidance of CA. Virtual surveillance workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. We present our initial experience with a focus on critical communications (CCs) to BTs. A retrospective, descriptive review of TCC activities was conducted from January 2019 to December 2022, involving electronic databases and electronic medical records of patients in the CICU, including related CCs to BTs, responses from BTs, and related CA. We conducted 18,171 TCC activities, including 2,678 non-CCs and 248 CCs. Over time, there was a significant increase in the proportion of CCs related with CT ( = 0.002), respiratory concerns (<0.001), and abnormalities in cardiac rhythm ( = 0.04). Among a sample of 244 CCs, subsequent interventions by BTs resulted in adjustment of medical treatment (127), respiratory support (68), surgery or intervention (19), cardiac rhythm control (17), imaging study (14), early resuscitation (9), and others (10). CCs from a TCC unit in a pediatric CICU changed over time with an increased focus on CT and resulted in early interventions, potentially contributing to avoiding CA. This model of care in pediatric cardiac critical care has the potential to improve patient safety.

APA Citation

Lopez Magallon, Alejandro; Saenz, Lucas; Mehta, Rittal; Chacón, Maria Angelica; Martinez Ransanz, Santiago; Swink, Kellie; Berris, Menchee; Hanabergh, Sofia; Yerebakan, Can; Wessel, David; and Munoz, Ricardo, "Pediatric Tele-Critical Care: Initial Experience with a Continuous Surveillance Model Aiming to Prevent Cardiac Arrest in Children with Critical Heart Disease" (2024). GW Authored Works. Paper 5038.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5038

Department

Pediatrics