title: Telemedicine as a tool to provide family conferences and palliative care consultations in critically ill patients at rural health care institutions: a pilot study.
abstract: BACKGROUND
  Many critically ill patients who transfer from rural hospitals to tertiary care centers (TCCs) have poor prognoses, and family members are unable to discuss patient prognosis and goals of care with TCC providers until after transfer.
  
  
  OBJECTIVE
  Our TCC conducted teleconferences prior to transfer to facilitate early family discussions.
  
  
  METHODS
  We conducted a retrospective review of these telemedicine family conferences among critically ill patients requested for transfer which occurred from December 2008 to December 2009 at our TCC. Outcomes for each patient and detailed descriptions of the conference content were obtained. We also assessed limitations and attitudes and satisfaction with this intervention among clinicians.
  
  
  RESULTS
  During the 12-month period, 12 telemedicine consultations were performed. Of these patients, 10 (83%) died in the 30 days following the request for transfer. After the telemedicine consultation, 8 (67%) patients were transferred to our TCC from their respective hospitals, while 4 (33%) patients continued care at their regional hospital and did not transfer. Of the patients who transferred to TCC, 7 (88% of those transferred) returned to their community after a stay at the TCC.
  
  
  CONCLUSIONS
  This study demonstrates that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility, and acceptability.
authors.affiliation: University of Vermont, Burlington, VT, USA Department of Medicine, Pulmonary Critical Care Medicine Division, University of Vermont, Burlington, VT, USA prema.menon@vtmednet.org.
authors.forename: Prema R
authors.initials: PR
authors.lastname: Menon
authors.affiliation: University of Vermont, Burlington, VT, USA Department of Medicine, Pulmonary Critical Care Medicine Division, University of Vermont, Burlington, VT, USA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
authors.affiliation: University of Vermont, Burlington, VT, USA Department of Family Medicine, University of Vermont, Burlington, VT, USA.
authors.forename: Ursula
authors.initials: U
authors.lastname: McVeigh
authors.affiliation: University of Vermont, Burlington, VT, USA Department of Psychiatry, University of Vermont, Burlington, VT, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Rabinowitz
mesh_terms: D001290:Attitude; D003258:Consumer Behavior; D016638:Critical Illness / Q000628:therapy*; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration; D010865:Pilot Projects; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*
keywords: communication in the ICU; palliative care; rural health care; telemedicine; telemedicine and communication