title: International telemedicine in pediatric cardiac critical care: a multicenter experience.
abstract: OBJECTIVE
  To describe our multicenter experience in telemedicine-assisted pediatric cardiac critical care (PCCC) with four hospitals in Latin America from July 2011 to June 2013.
  
  
  METHODS
  This was a descriptive study based on telemedicine encounters related to quality of communication, assessed information, activities, and recommendations. Comparison among centers was performed. A postimplementation survey was conducted through a 5-point Likert scale questionnaire investigating acceptance among professionals involved with the telemedicine service through the assessment of general satisfaction, perception about the work system, usefulness, and impact on medical practice.
  
  
  RESULTS
  One thousand forty consultations were conducted for 476 patients. Postoperatively, patients were distributed into Risk Adjustment Classification for Congenital Heart Surgery (RACHS-1) categories as follows: 2%, 26%, 36%, 26%, and 10% in categories 1, 2, 3, 4, and 6, respectively. A real-time intervention took place in 23% of encounters. Of the 2,173 recommendations given, 70 were related to extracorporeal membrane oxygenation management. There was a different RACHS-1 distribution and encounter characteristics among centers. From a total of 51 surveys sent, 27 responses were received, and among responders, overall satisfaction was very high (4.27 ± 0.18), as well as work system quality (4.4 ± 0.37). Telemedicine was considered useful in the cardiac intensive care unit (3.86 ± 0.60), for patient outcomes (3.8 ± 0.51), and for education (3.7 ± 0.71). There was a difference in overall satisfaction, perception about telemedicine usefulness in education, and impact on medical practice among centers.
  
  
  CONCLUSIONS
  An international, multicenter telemedicine program in PCCC is technologically and logistically feasible. Prospective interventions in our international multicenter telemedicine program should consider differences in staff composition, perception of needs, and patient population among centers.
authors.affiliation: 1 Division of Pediatric Cardiac Critical Care, Children's Hospital of the University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
authors.forename: Andrea Victoria
authors.initials: AV
authors.lastname: Otero
authors.forename: Alejandro Jose
authors.initials: AJ
authors.lastname: Lopez-Magallon
authors.forename: Diana
authors.initials: D
authors.lastname: Jaimes
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Motoa
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruz
authors.forename: Julio
authors.initials: J
authors.lastname: Erdmenger
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Muñoz
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D038622:Internationality; D007843:Latin America; D008297:Male; D015397:Program Evaluation; D011787:Quality of Health Care; D017216:Telemedicine / Q000458:organization & administration*
keywords: cardiology/cardiovascular disease; pediatrics; telecardiology; telemedicine