Download PDF
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 
1   Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
2   Children's Health Research Institute, London, Ontario, Canada
,
Michael R. Miller
1   Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
2   Children's Health Research Institute, London, Ontario, Canada
,
Christopher S. Parshuram
3   Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
4   Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
5   Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
6   The Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

23 November 2018

13 January 2019

Publication Date:
25 February 2019 (online)

    Permissions and Reprints

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

Supplementary Material

 

  • References

  • 1 Holmes MJ, Reyes HM. A critical review of urban pediatric trauma. J Trauma 1984; 24 (03) 253-255
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Pearson G, Shann F, Barry P. , et al. Should paediatric intensive care be centralised? Trent versus Victoria. Lancet 1997; 349 (9060): 1213-1217
    CrossrefPubMedGoogle Scholar
  • 6 CritiCall O. Available at: https://www.phrs.criticall.org/User/LogIn?ReturnUrl=%2f
    PubMed
  • 7 Wadhwa A, Lingard L. A qualitative study examining tensions in interdoctor telephone consultations. Med Educ 2006; 40 (08) 759-767
    CrossrefPubMedGoogle Scholar
  • 8 Cartmill M, White BD. Telephone advice for neurosurgical referrals. Who assumes duty of care?. Br J Neurosurg 2001; 15 (06) 453-455
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ 1989; 298 (6670): 366-370
    CrossrefPubMedGoogle Scholar
  • 12 Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med 2004; 79 (02) 186-194
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 27 Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care 2003; 48 (04) 386-396 , discussion 397–398
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 van Veen M, Steyerberg EW, Ruige M. , et al. Manchester triage system in paediatric emergency care: prospective observational study. BMJ 2008; 337: a1501
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar