Telemedicine for Pediatric Emergency Care

Recruiting at1 trial location

Overseen by Tehnaz Boyle, MD PhD

Age: < 18

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Boston Medical Center

Disqualifiers: Non-respiratory complaints, Life-threatening illness, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Teleconsultation, or the use of video telecommunications technology to deliver expert recommendations for care remotely, has been used to improve the safety and quality of emergency care for children in hospital-based acute care settings by providing real-time access to remote pediatric physician experts. Whether extending teleconsultation as a patient safety intervention to emergency medical systems (EMS) outside hospitals can similarly benefit sick and injured children in the community is unknown. Advances in mobile technology have made teleconsultation more accessible and affordable for EMS systems. However, this intervention has been underutilized by EMS partially due to the lack of prehospital research supporting its efficacy for pediatric applications. In prior simulation studies, the investigators found high intervention acceptance among key stakeholder groups (pediatric emergency physicians and paramedics), and demonstrated that it was feasible to integrate video communication into prehospital clinical workflows involving critical care delivery in high-risk pediatric scenarios. These initial simulation studies were conducted in a controlled prehospital setting in static ambulances using infant simulator manikins to minimize risk to children and providers. Demonstrating feasibility and acceptability with real children in moving ambulances is the next step to build the necessary evidence base to support future planned prehospital efficacy trials with children. The investigators hypothesize that remote respiratory assessment of children by medical control physicians (expert physicians) using a mobile teleconsultation platform is acceptable to users (physicians and transport providers), and technically feasible in real transports.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Teleconsultation in the clinical trial Telemedicine for Pediatric Emergency Care?

Research shows that telemedicine consultations can improve the quality of care for critically ill children in rural emergency departments, and they may lead to better outcomes when children are transferred to specialized hospitals. ^{1 2 3 4 5}

Is telemedicine safe for pediatric emergency care?

Research suggests that telemedicine in pediatric emergency care is generally safe, but there are concerns about accurately assessing the urgency of a child's condition remotely. Studies have focused on ensuring that medical diagnoses and decisions made through telemedicine are appropriate and reasonable. ^{1 3 6 7 8}

How is telemedicine unique for pediatric emergency care?

Telemedicine for pediatric emergency care is unique because it allows children in underserved areas to access specialized medical care without needing to travel to a children's hospital. This approach can help reduce disparities in healthcare access and improve the quality of care for critically ill pediatric patients. ^{1 8 9 10 11}

Research Team

Tehnaz Boyle, MD PhD

Principal Investigator

Boston Medical Center

Eligibility Criteria

This trial is for children in New England with respiratory illnesses who are stable enough for transport by Boston Children's Hospital. They must need things like extra oxygen, medications, or be stable on a ventilator. Kids can't join if their parents don't speak English, they have non-respiratory issues, or are too sick and might need emergency care during the ride.

Inclusion Criteria

I am stable enough for travel, even if I need help like oxygen or medication.

Children in New England who were taken to Boston Children's Hospital for any respiratory illness.

Exclusion Criteria

Non-English speaking parents/guardians

My child has health issues not related to breathing.

Children whose condition is expected to be very serious and needing urgent medical care during transportation.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Teleconsultation

Transport providers initiate a video-call from the ambulance to a medical control physician for remote respiratory assessment of children

6 months

Ongoing during each transport

Follow-up

Participants are monitored for acceptability and feasibility of the teleconsultation platform using a validated questionnaire

6 months

Treatment Details

Interventions

• Teleconsultation (Behavioural Intervention)

Trial Overview The study tests if doctors can use video calls to check on kids with breathing problems during ambulance rides. It checks whether this teleconsultation is doable and okay with everyone involved—like the medical staff and families—in real-life situations outside of hospitals.

Participant Groups

Group I: Teleconsultation group Experimental Treatment 1 Intervention

Eligible children managed by urban paramedic teams responding to 911 calls in the prehospital setting to support a future trial of clinical efficacy.

Who Is Running the Clinical Trial?

Boston Medical Center

Lead Sponsor

Trials

410

Recruited

890,000+

Dr. Alastair Bell

Boston Medical Center

Chief Executive Officer since 2023

MD from University of Oxford, MBA from Harvard Business School

Dr. Ravin Davidoff

Boston Medical Center

Chief Medical Officer since 2008

M.B., B.Ch. from University of Witwatersrand, South Africa

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Dr. Gary H. Gibbons

National Heart, Lung, and Blood Institute (NHLBI)

Chief Executive Officer since 2012

MD from Harvard Medical School

Dr. James P. Kiley

National Heart, Lung, and Blood Institute (NHLBI)

Chief Medical Officer since 2011

MD from University of California, San Francisco

Findings from Research

A qualitative study involving 16 healthcare professionals revealed that addressing biases against telemedicine is crucial for increasing its adoption in pediatric emergency care.

Telemedicine enhances collaboration among healthcare providers and families, but to improve its use, processes must adapt to include various technologies and allow more healthcare staff, like nurses, to participate in consultations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. Sauers-Ford, HS., Hamline, MY., Gosdin, MM., et al.[2020]

In a study of 320 critically ill children in rural emergency departments, telemedicine consultations provided the highest quality of care compared to telephone consultations and no consultations, as rated by pediatric emergency medicine physicians.

Parents reported significantly higher satisfaction and perceived quality of care when telemedicine was used, and telemedicine led to more frequent changes in diagnosis and treatment by referring physicians compared to telephone consultations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of critical care telemedicine consultations on children in rural emergency departments. Dharmar, M., Romano, PS., Kuppermann, N., et al.[2022]

Children admitted to the PICU from emergency departments with access to pediatric telemedicine were younger and less severely ill compared to those from departments without telemedicine, indicating that telemedicine may help in better managing critical cases before transfer.

After implementing telemedicine, the severity of illness in children transferred from emergency departments significantly decreased, suggesting that telemedicine programs can improve initial care and potentially lead to better clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children's Hospital PICU. Dayal, P., Hojman, NM., Kissee, JL., et al.[2019]

Synchronous telemedicine in pediatric acute care settings has been associated with improved quality of care, reduced transfer rates (by 31-87.5%), and shorter hospital stays (averaging 8.2 days compared to 15.1 days).

Despite these positive outcomes, the overall quality of the studies reviewed was weak, indicating a need for more robust research to confirm the clinical effectiveness of telemedicine in these settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review. Nadar, M., Jouvet, P., Tucci, M., et al.[2023]

During a 6-month study period, the pediatric emergency department received an average of 2.15 calls per day, with common concerns including fever (27%), digestive issues (22%), and trauma (14%), indicating a significant demand for telephone advice in pediatric care.

About 30% of the calls did not require medical advice, suggesting that many parents were seeking general orientation rather than urgent care, highlighting the need for improved protocols to address common inquiries effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Pediatric telephone advice in the emergency department]. Dufour, D., Paon, JC., Marshall, B., et al.[2006]

The pediatric telemedicine service demonstrated high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), indicating that online physicians are making accurate assessments in most cases.

Despite the overall high safety levels, with low false-positive (2.65%) and false-negative (5.3%) rates, there is a need for ongoing improvements to enhance diagnostic accuracy and treatment quality in tele-triage settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. Haimi, M., Brammli-Greenberg, S., Baron-Epel, O., et al.[2020]

In a study of 138 acutely ill and injured children in rural emergency departments, those receiving telemedicine consultations had a significantly lower hospital admission rate (59.5%) compared to those receiving telephone consultations (87.5%), suggesting that telemedicine may lead to more appropriate care.

Despite the lower admission rate with telemedicine, the observed-to-expected admission ratios were not statistically different between the two groups, indicating that both consultation methods provided similar levels of care quality, which supports the use of telemedicine in pediatric emergency settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Appropriateness of disposition following telemedicine consultations in rural emergency departments. Yang, NH., Dharmar, M., Kuppermann, N., et al.[2022]

General emergency department providers see potential in pediatric telemedicine for improving care, particularly in guiding diagnoses and managing low-frequency, high-stakes situations, based on interviews with 18 providers.

However, they also noted limitations such as infrequent need for telemedicine and barriers to implementation, suggesting that further research is needed to evaluate its effectiveness and cost before widespread use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine. Kim, JW., Tiyyagura, G., Langhan, M.[2020]

A pilot study evaluating a telemedicine program for critically ill pediatric patients in the emergency department showed positive perceptions from both parents and physicians, highlighting its effectiveness in providing rapid access to specialized care.

The program facilitated better communication between local and remote physicians, although the study faced limitations related to sample size and response rate, indicating a need for further research to validate these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining perceptions of a telemedicine network for pediatric emergency medicine: a mixed-methods pilot study. Mateus, LA., Law, MP., Khowaja, AR., et al.[2023]

A survey of 25 respondents from 20 pediatric emergency telemedicine programs revealed that while reimbursement is less of a barrier, challenges like cross-hospital credentialing and integration into existing workflows significantly hinder the widespread use of telemedicine in pediatric emergency care.

Successful implementation of pediatric emergency telemedicine relies on selecting hospitals that are receptive to the program and having local clinical champions to promote its use, highlighting the importance of local support and adaptability in overcoming barriers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Barriers and facilitators to pediatric emergency telemedicine in the United States. Uscher-Pines, L., Kahn, JM.[2021]

Telemedicine shows promise in pediatric emergency medicine by enabling real-time decision-making, which could enhance the quality of care for children.

However, there are logistical and legal challenges to its implementation, and further research is needed to determine its impact on clinical outcomes and to address practical issues like training and resource allocation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telemedicine Applications for the Pediatric Emergency Medicine: A Review of the Current Literature. Gattu, R., Teshome, G., Lichenstein, R.[2016]

References

1. United States pubmed.ncbi.nlm.nih.gov

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Impact of critical care telemedicine consultations on children in rural emergency departments. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children's Hospital PICU. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review. [2023]

5. France pubmed.ncbi.nlm.nih.gov

[Pediatric telephone advice in the emergency department]. [2006]

6. England pubmed.ncbi.nlm.nih.gov

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Appropriateness of disposition following telemedicine consultations in rural emergency departments. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine. [2020]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Examining perceptions of a telemedicine network for pediatric emergency medicine: a mixed-methods pilot study. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Barriers and facilitators to pediatric emergency telemedicine in the United States. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Telemedicine Applications for the Pediatric Emergency Medicine: A Review of the Current Literature. [2016]