Skip to main content
SpringerLink
Log in
Book cover

Pediatric Critical Care Medicine pp 75–82Cite as

Telemedicine in the Pediatric Intensive Care Unit

  • Chapter
  • First Online:

  • 3448 Accesses

Abstract

Telemedicine technologies involve real-time, live interactive high-definition video and audio communication that allow pediatric critical care physicians to have a virtual presence at the bedside of any critically ill child. Telemedicine use has been increasing and is expected to become a common tool in remote emergency departments, inpatient wards, and Intensive Care Units for pediatric care. There is increasing data to support new care models that incorporate telemedicine technologies result in higher care quality, more efficient resource use with improved cost-effectiveness, and higher patient, parent and remote provider satisfaction. As more research is conducted, the best use of these technologies will be better defined, and result in increased access to pediatric critical care expertise to a larger population of children in need of Pediatric Intensive Care Unit (PICU) services.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23(2):294–300.

    Article  PubMed  CAS  Google Scholar 

  2. Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the leapfrog initiative. Surgery. 2001;130(3):415–22.

    Article  PubMed  CAS  Google Scholar 

  3. Phibbs CS, Bronstein JM, Buxton E, Phibbs RH. The effects of patient volume and level of care at the hospital of birth on neonatal mortality. JAMA. 1996;276(13):1054–9.

    Article  PubMed  CAS  Google Scholar 

  4. Tilford JM, Simpson PM, Green JW, Lensing S, Fiser DH. Volume-outcome relationships in pediatric intensive care units. Pediatrics. 2000;106(2 Pt 1):289–94.

    Article  PubMed  CAS  Google Scholar 

  5. Marcin JP, Li Z, Kravitz RL, Dai JJ, Rocke DM, Romano PS. The CABG surgery volume-outcome relationship: temporal trends and selection effects in California, 1998–2004. Health Serv Res. 2008;43(1 Pt 1):174–92.

    PubMed Central  PubMed  Google Scholar 

  6. Marcin JP, Song J, Leigh JP. The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis. Pediatr Crit Care Med. 2005;6(2):136–41.

    Article  PubMed  Google Scholar 

  7. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128–37.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Lorch SA, Myers S, Carr B. The regionalization of pediatric health care. Pediatrics. 2010;126(6):1182–90.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288(17):2151–62.

    Article  PubMed  Google Scholar 

  10. Blunt MC, Burchett KR. Out-of-hours consultant cover and case-mix-adjusted mortality in intensive care. Lancet. 2000;356(9231):735–6.

    Article  PubMed  CAS  Google Scholar 

  11. 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(2):150–9.

    Article  PubMed  CAS  Google Scholar 

  12. Pollack MM, Cuerdon TT, Patel KM, Ruttimann UE, Getson PR, Levetown M. Impact of quality-of-care factors on pediatric intensive care unit mortality. JAMA. 1994;272(12):941–6.

    Article  PubMed  CAS  Google Scholar 

  13. Kanter RK. Regional variation in child mortality at hospitals lacking a pediatric intensive care unit. Crit Care Med. 2002;30(1):94–9.

    Article  PubMed  Google Scholar 

  14. Dharmar M, Marcin JP, Romano PS, et al. Quality of care of children in the emergency department: association with hospital setting and physician training. J Pediatr. 2008;153(6):783–9.

    Article  PubMed  Google Scholar 

  15. Marcin JP, Dharmar M, Cho M, et al. Medication errors among acutely ill and injured children treated in rural emergency departments. Ann Emerg Med. 2007;50(4):361–7. 367.e361–2.

    Article  PubMed  Google Scholar 

  16. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich Jr J. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284(21):2762–70.

    Article  PubMed  CAS  Google Scholar 

  17. Pediatrician workforce statement. Pediatrics. 2005;116(1):263–9.

    Google Scholar 

  18. Marcin J, Ellis J, Mawis R, Nagrampa E, Nesbitt T, Dimand R. Telemedicine and the medical home: providing pediatric subspecialty care to children with special health care needs in an underserved rural community. Pediatrics. 2004;113(1 Pt 1):1–6.

    Article  PubMed  Google Scholar 

  19. Marcin JP, Ellis J, Mawis R, Nagrampa E, Nesbitt TS, Dimand RJ. Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community. Pediatrics. 2004;113(1 Pt 1):1–6.

    Article  PubMed  Google Scholar 

  20. Haskins PA, Ellis DG, Mayrose J. Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports. Prehosp Emerg Care. 2002;6(4):445–8.

    Article  PubMed  Google Scholar 

  21. Tsai SH, Kraus J, Wu HR, et al. The effectiveness of video-telemedicine for screening of patients requesting Emergency Air Medical Transport (EAMT). J Trauma. 2007;62(2):504–11.

    Article  PubMed  Google Scholar 

  22. Athey J, Dean JM, Ball J, Wiebe R, Melese-d’Hospital I. Ability of hospitals to care for pediatric emergency patients. Pediatr Emerg Care. 2001;17(3):170–4.

    Article  PubMed  CAS  Google Scholar 

  23. McGillivray D, Nijssen-Jordan C, Kramer MS, Yang H, Platt R. Critical pediatric equipment availability in Canadian hospital emergency departments. Ann Emerg Med. 2001;37(4):371–6.

    Article  PubMed  CAS  Google Scholar 

  24. Bowman SM, Zimmerman FJ, Christakis DA, Sharar SR, Martin DP. Hospital characteristics associated with the management of pediatric splenic injuries. JAMA. 2005;294(20):2611–7.

    Article  PubMed  CAS  Google Scholar 

  25. Middleton KR, Burt CW. Availability of pediatric services and equipment in emergency departments: United States, 2002–03. Adv Data. 2006;367:1–16.

    PubMed  Google Scholar 

  26. Gausche-Hill M, Schmitz C, Lewis RJ. Pediatric preparedness of US emergency departments: a 2003 survey. Pediatrics. 2007;120(6):1229–37.

    Article  PubMed  Google Scholar 

  27. Bourgeois FT, Shannon MW. Emergency care for children in pediatric and general emergency departments. Pediatr Emerg Care. 2007;23(2):94–102.

    Article  PubMed  Google Scholar 

  28. Tilford JM, Roberson PK, Lensing S, Fiser DH. Improvement in pediatric critical care outcomes. Crit Care Med. 2000;28(2):601–3.

    Article  PubMed  CAS  Google Scholar 

  29. Keeler EB, Rubenstein LV, Kahn KL, et al. Hospital characteristics and quality of care. JAMA. 1992;268(13):1709–14.

    Article  PubMed  CAS  Google Scholar 

  30. Seidel JS, Henderson DP, Ward P, Wayland BW, Ness B. Pediatric prehospital care in urban and rural areas. Pediatrics. 1991;88(4):681–90.

    PubMed  CAS  Google Scholar 

  31. Seidel JS, Hornbein M, Yoshiyama K, Kuznets D, Finklestein JZ, Jr. St Geme JW. Emergency medical services and the pediatric patient: are the needs being met? Pediatrics. 1984;73(6):769–72.

    PubMed  CAS  Google Scholar 

  32. Durch J, Lohr KN, Institute of Medicine (U.S.), Committee on Pediatric Emergency Medical Services. Emergency medical services for children. Washington, DC: National Academy Press; 1993.

    Google Scholar 

  33. Durch JS, Lohr KN. From the Institute of Medicine. JAMA. 1993;270(8):929.

    Article  PubMed  CAS  Google Scholar 

  34. Lambrecht CJ. Emergency physicians’ roles in a clinical telemedicine network. Ann Emerg Med. 1997;30(5):670–4.

    Article  PubMed  CAS  Google Scholar 

  35. Brennan JA, Kealy JA, Gerardi LH, et al. Telemedicine in the emergency department: a randomized controlled trial. J Telemed Telecare. 1999;5(1):18–22.

    Article  PubMed  CAS  Google Scholar 

  36. Brennan JA, Kealy JA, Gerardi LH, et al. A randomized controlled trial of telemedicine in an emergency department. J Telemed Telecare. 1998;4 Suppl 1:18–20.

    Article  PubMed  Google Scholar 

  37. Stamford P, Bickford T, Hsiao H, Mattern W. The significance of telemedicine in a rural emergency department. IEEE Eng Med Biol Mag. 1999;18(4):45–52.

    Article  PubMed  CAS  Google Scholar 

  38. Rogers FB, Ricci M, Caputo M, et al. The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results. J Trauma. 2001;51(6):1037–41.

    Article  PubMed  CAS  Google Scholar 

  39. Latifi R, Hadeed GJ, Rhee P, et al. Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients. Am J Surg. 2009;198(6):905–10.

    Article  PubMed  Google Scholar 

  40. Hicks LL, Boles KE, Hudson ST, et al. Using telemedicine to avoid transfer of rural emergency department patients. J Rural Health. 2001;17(3):220–8.

    Article  PubMed  CAS  Google Scholar 

  41. Kofos D, Pitetti R, Orr R, Thompson A. Telemedicine in pediatric transport: a feasibility study. Pediatrics. 1998;102(5):E58.

    Article  PubMed  CAS  Google Scholar 

  42. Emsley H, Blacker K, Davies P, O’Donnell M. Telestroke. When location, location, location doesn’t matter. Health Serv J. 2010;120(6227):24–5.

    PubMed  Google Scholar 

  43. Demaerschalk BM, Hwang HM, Leung G. Cost analysis review of stroke centers, telestroke, and rt-PA. Am J Manag Care. 2010;16(7):537–44.

    PubMed  Google Scholar 

  44. Pervez MA, Silva G, Masrur S, et al. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke. 2010;41(1):e18–24.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Galli R, Keith JC, McKenzie K, Hall GS, Henderson K. TelEmergency: a novel system for delivering emergency care to rural hospitals. Ann Emerg Med. 2008;51(3):275–84.

    Article  PubMed  Google Scholar 

  46. 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(5):588–91.

    Article  PubMed  Google Scholar 

  47. Henderson K. TelEmergency: distance emergency care in rural emergency departments using nurse practitioners. J Emerg Nurs. 2006;32(5):388–93.

    Article  PubMed  Google Scholar 

  48. Duchesne JC, Kyle A, Simmons J, et al. Impact of telemedicine upon rural trauma care. J Trauma. 2008;64(1):92–7; discussion 97–8.

    Article  PubMed  Google Scholar 

  49. Dharmar M, Romano PS, Kuppermann N, Nesbitt TS, Cole SL, Andrada ER, Vance C, Harvey DJ, Marcin JP. Impact of critical care telemedicine consultations on children in rural emergency departments. Crit Care Med. 2013;41(10):2388–95.

    Article  PubMed  Google Scholar 

  50. Dharmar M, Marcin JP. A picture is worth a thousand words: critical care consultations to emergency departments using telemedicine. Pediatr Crit Care Med. 2009;10(5):606–7.

    Article  PubMed  Google Scholar 

  51. Dharmar M, Marcin JP, Kuppermann N, et al. A new implicit review instrument for measuring quality of care delivered to pediatric patients in the emergency department. BMC Emerg Med. 2007;7:13.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Qureshi A, Shih E, Fan I, et al. Improving patient care by unshackling telemedicine: adaptively aggregating wireless networks to facilitate continuous collaboration. AMIA Proc Annu Symp. 2010;2010:662–6.

    Google Scholar 

  53. Hsieh JC, Lin BX, Wu FR, Chang PC, Tsuei YW, Yang CC. Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists. Telemed J E Health. 2010;16(8):910–5.

    Article  PubMed  Google Scholar 

  54. Charash WE, Caputo MP, Clark H, et al. Telemedicine to a moving ambulance improves outcome after trauma in simulated patients. J Trauma. 2011;71(1):49–55.

    Article  PubMed  Google Scholar 

  55. Rosenberg DI, Moss MM. Guidelines and levels of care for pediatric intensive care units. Crit Care Med. 2004;32(10):2117–27.

    Article  PubMed  Google Scholar 

  56. Merenstein D, Egleston B, Diener-West M. Lengths of stay and costs associated with children’s hospitals. Pediatrics. 2005;115(4):839–44.

    Article  PubMed  Google Scholar 

  57. Odetola FO, Gebremariam A, Freed GL. Patient and hospital correlates of clinical outcomes and resource utilization in severe pediatric sepsis. Pediatrics. 2007;119(3):487–94.

    Article  PubMed  Google Scholar 

  58. Gupta RS, Bewtra M, Prosser LA, Finkelstein JA. Predictors of hospital charges for children admitted with asthma. Ambul Pediatr. 2006;6(1):15–20.

    Article  PubMed  Google Scholar 

  59. Dharmar M, Smith AC, Armfield NR, Trujano J, Sadorra C, Marcin JP. Telemedicine for children in need of intensive care. Pediatr Ann. 2009;38(10):562–6.

    Article  PubMed  Google Scholar 

  60. Marcin JP, Nesbitt TS, Kallas HJ, Struve SN, Traugott CA, Dimand RJ. Use of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California. J Pediatr. 2004;144(3):375–80.

    Article  PubMed  Google Scholar 

  61. Marcin JP, Schepps DE, Page KA, Struve SN, Nagrampa E, Dimand RJ. The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: a preliminary report. Pediatr Crit Care Med. 2004;5(3):251–6.

    Article  PubMed  Google Scholar 

  62. Huang T, Moon-Grady AJ, Traugott C, Marcin J. The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit. J Telemed Telecare. 2008;14(5):244–8.

    Article  PubMed  Google Scholar 

  63. Kon AA, Rich B, Sadorra C, Marcin JP. Complex bioethics consultation in rural hospitals: using telemedicine to bring academic bioethicists into outlying communities. J Telemed Telecare. 2009;15(5):264–7.

    Article  PubMed  Google Scholar 

  64. Marcin JP, Nesbitt TS, Struve S, Traugott C, Dimand RJ. Financial benefits of a pediatric intensive care unitbased telemedicine program to a rural adult intensive care unit: impact of keeping acutely ill and injured children in their local community. Telemed J E Health. 2004;10:1–5.

    Article  Google Scholar 

  65. Rosenfeld BA, Dorman T, Breslow MJ, et al. Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Crit Care Med. 2000;28(12):3925–31.

    Article  PubMed  CAS  Google Scholar 

  66. Breslow MJ, Rosenfeld BA, Doerfler M, et al. Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing. Crit Care Med. 2004;32(1):31–8.

    Article  PubMed  Google Scholar 

  67. Thomas EJ, Lucke JF, Wueste L, Weavind L, Patel B. Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay. JAMA. 2009;302(24):2671–8.

    Article  PubMed  CAS  Google Scholar 

  68. Franzini L, Sail KR, Thomas EJ, Wueste L. Costs and cost-effectiveness of a telemedicine intensive care unit program in 6 intensive care units in a large health care system. J Crit Care. 2011;26(3):329.e321–6.

    Article  Google Scholar 

  69. Morrison JL, Cai Q, Davis N, et al. Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals. Crit Care Med. 2010;38(1):2–8.

    Article  PubMed  Google Scholar 

  70. McCambridge M, Jones K, Paxton H, Baker K, Sussman EJ, Etchason J. Association of health information technology and teleintensivist coverage with decreased mortality and ventilator use in critically ill patients. Arch Intern Med. 2010;170(7):648–53.

    Article  PubMed  Google Scholar 

  71. Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med. 2011;171(6):498–506.

    Article  PubMed  Google Scholar 

  72. Smith AC, Armfield NR. A systematic review and meta-analysis of ICU telemedicine reinforces the need for further controlled investigations to assess the impact of telemedicine on patient outcomes. Evid Based Nurs. 2011;14(4):102–3. Epub 2011 Aug 2.

    Article  PubMed  Google Scholar 

  73. Kahn JM. Intensive care unit telemedicine: promises and pitfalls. Arch Intern Med. 2011;171(6):495–6.

    Article  PubMed  Google Scholar 

  74. Lilly CM, Cody S, Zhao H, et al. Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011;305(21):2175–83.

    Article  PubMed  CAS  Google Scholar 

  75. Kahn JM. The use and misuse of ICU telemedicine. JAMA. 2011;305(21):2227–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, UC Davis Children’s Hospital, 2516 Stockton Boulevard, Sacramento, CA, 95817, USA

    James P. Marcin MD, MPH, Madan Dharmar MBBS, PhD & Candace Sadorra BS

Authors
  1. James P. Marcin MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Madan Dharmar MBBS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Candace Sadorra BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James P. Marcin MD, MPH .

Editor information

Editors and Affiliations

  1. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Marcin, J.P., Dharmar, M., Sadorra, C. (2014). Telemedicine in the Pediatric Intensive Care Unit. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6362-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6362-6_8

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6361-9

  • Online ISBN: 978-1-4471-6362-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation