title: Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study.
abstract: BACKGROUND
  Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments.
  
  
  METHODS
  Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed.
  
  
  RESULTS
  Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P = .01), mean time to diagnosis (100 vs 147 min, P < .001), mean length of stay (1.0 vs 26 days, P = .005) and length of intensive care unit stay (0.96 vs 2.5 days, P = .024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28).
  
  
  CONCLUSIONS
  Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients.
authors.affiliation: University of Michigan Congenital Heart Center, Ann Arbor, MI 48109, USA. webbcl@med.umich.edu
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Webb
authors.forename: Carol L
authors.initials: CL
authors.lastname: Waugh
authors.forename: Jim
authors.initials: J
authors.lastname: Grigsby
authors.forename: David
authors.initials: D
authors.lastname: Busenbark
authors.forename: Kaliope
authors.initials: K
authors.lastname: Berdusis
authors.forename: David J
authors.initials: DJ
authors.lastname: Sahn
authors.forename: Craig A
authors.initials: CA
authors.lastname: Sable
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D016555:Matched-Pair Analysis; D011446:Prospective Studies; D019114:Remote Consultation / Q000706:statistics & numerical data; D017216:Telemedicine / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States; D019564:Unnecessary Procedures; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: ANOVA; Analysis of variance; Congenital heart disease; ICU; Intensive care unit; LOS; Length of stay; Telemedicine