PEDIATRIC VIRTUAL CRITICAL CARE Pilot Study: A qualitative assessment survey
CCCF ePoster library. Dhanani S. 11/12/19; 283387; EP57
Dr. Sonny Dhanani
Dr. Sonny Dhanani
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Topic: Quality Assurance & Improvement

Fuad Alnaji,1,2; Colleen Fitzgibbons,1; Christa Ramsay,1; Erin Larmer,1; Indira Izmailova,1; Bryan Makara,1; Marilyn Vibe,3; Derek Manchuk,4; Sonny Dhanani,1,2
1 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
2 Department of Pediatrics, University of Ottawa, , Ottawa, Ontario, Canada
3 Ontario Telemedicine Network, , Ontario, Canada
4 Critical Care Medicine, Health Science North, Sudbury, Ontario, Canada

Telemedicine is the use of telecommunication and technology to deliver health care remotely.  Pediatric critical care expertise is concentrated within tertiary care centers.
In Ontario, remote health care centers seek pediatric critical care consultation through a centralized system by telephone. The call would connect the health care physician with the consulting physician. Discussion of the case details occurs and advice is given. This may result in transporting the patient to the consulted critical care unit.
Critical Care Response Teams (CCRT) compromised of MD's, Respiratory Therapists (RT's) and Registered Nurses (RN's) bring specialized multidisciplinary knowledge to the bedside when critical care service is consulted.
As an adjunct to the traditional extramural consultation service, we conducted a pilot quality improvement initiative using telemedicine or Pediatric Virtual Critical Care (PVCC) to connect a remote center (North Bay Regional Health Centre (NBRHC)) with the pediatric CCRT at the Children's Hospital of Eastern Ontario (CHEO) as an extra resource to supplement the traditional telephone MD-only consultation. We conducted a qualitative survey of the teams at NBRHC and CHEO to assess this novel initiative.
The project team developed the project documentation: project charter & work plan, guidelines, teaching materials and posters. A survey was developed by the PVCC team.  Upon completion of each consultation, the survey was distributed to all participants from both sides in either paper or electronic forms. Free text space for comments was allowed. Respondents were anonymous.
Prior to the initiation of the PVCC trial, our quality team implemented the project charter which included educating teams on the work plan and algorithm as well as the use of technology. Multiple mock PVCC codes were conducted by the nursing educators on both sites to assess the quality of the process and troubleshoot issues prior to implementation.
Between December 2016 and May 2019, a total of 41 PVCC calls were completed involving 27 primary activations and 14 follow up visits.
A total of 83 survey responses were received with 60 from CHEO and 23 from NBRHC. 51.5% of the surveys were completed by MD's, 40% by RN's and 8.5% by RT's.
In assessing the ease of the PVCC process, all participants at NBRHC and 88% of participants at CHEO felt that it was easy.
All the teams felt that the multidisciplinary resources were valuable. 90% of people at both sites thought that the educational benefit was better than a phone consultation.
88-95% of participants agreed that the ability to involve family in the consolation was valuable and felt that this was a huge asset to the program.
90% of the participants thought that the educational benefit was better than a phone consultation and felt more comfortable treating pediatric patients with PVCC vs phone consultation. 95 % felt that the PVCC improves the quality of care compared with a telephone.
After PVCC, 14/27 patients remained at their hospital with the support of CHEO's CCRT.
PVCC presents a valuable resource in supporting remote teams caring for critically ill pediatric patients by providing multidisciplinary advice and family involvement in consultations.  PVCC increases clinician comfort when caring for pediatric patients. Preventing transfer can add significant savings to the health care system. This model is easy to implement using current resources.

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