The effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.
BACKGROUND
In many health systems, specialist services for critically ill children are typically regionalised or centralised. Studies have shown that high-risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality. In acute cases where distance and time impede access to specialist care, clinical advice may be provided remotely by telephone. Emergency retrieval services, attended by medical and nursing staff may be used to transport patients to specialist centres. Even with the best quality retrieval services, stabilisation of the patient and transport logistics may delay evacuation to definitive care. Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children. However, no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval.


METHODS
The study is a pragmatic, multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit. We aim to recruit 160 children for whom a specialist retrieval consultation is required. The primary outcome measure is stabilisation time (time spent on site at the referring hospital by the retrieval team) adjusted for initial risk. Secondary outcome measures are change in patient's physiological status (repeated measure, two time points) scored using the Children's Emergency Warning Tool; change in diagnosis (repeated measure taken at three time points); change in destination of retrieved patients at the tertiary hospital (general ward or paediatric intensive care unit); retrieval decision, and length of stay in the Paediatric Intensive Care Unit for retrieved patients. The trial has been approved by the Human Research Ethics Committees of Children's Health Services Queensland and The University of Queensland, Australia.


CONCLUSIONS
Health services are adopting telemedicine, however formal evidence to support its use in paediatric acute care is limited. Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval.


BACKGROUND
Australian and New Zealand Clinical Trials Registry ACTRN12612000156886 .
Centre for Online Health, School of Medicine, The University of Queensland, Brisbane, Australia. N.R.Armfield@uq.edu.au.|Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia. N.R.Armfield@uq.edu.au.|Centre for Online Health, Royal Children's Hospital, Level 3, Foundation Building, Herston, Queensland, 4029, Australia. N.R.Armfield@uq.edu.au.
Nigel R
NR
Armfield
Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia. Mark.Coulthard@health.qld.gov.au.|Academic Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia. Mark.Coulthard@health.qld.gov.au.|Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Australia. Mark.Coulthard@health.qld.gov.au.
Mark G
MG
Coulthard
Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Australia. Anthony.Slater@health.qld.gov.au.
Anthony
A
Slater
Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Australia. Julie.McEniery@health.qld.gov.au.
Julie
J
McEniery
Retrieval Services Queensland, Department of Health, Brisbane, Australia. Mark.Elcock@health.qld.gov.au.
Mark
M
Elcock
Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia. R.Ware@sph.uq.edu.au.|School of Population Health, The University of Queensland, Brisbane, Australia. R.Ware@sph.uq.edu.au.
Robert S
RS
Ware
Griffith Health Institute, School of Medicine, Griffith University, Brisbane, Australia. P.Scuffham@griffith.edu.au.
Paul A
PA
Scuffham
Centre for Online Health, School of Medicine, The University of Queensland, Brisbane, Australia. MBensink@live.com.
Mark E
ME
Bensink
Centre for Online Health, School of Medicine, The University of Queensland, Brisbane, Australia. asmith@uq.edu.au.|Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia. asmith@uq.edu.au.
Anthony C
AC
Smith
D000293:Adolescent; D001315:Australia; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration; D004630:Emergencies / Q000451:nursing*; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008297:Male; D009520:New Zealand; D010372:Pediatrics / Q000458:organization & administration*; D015397:Program Evaluation; D011793:Queensland; D012017:Referral and Consultation / Q000458:organization & administration*; D012107:Research Design; D017216:Telemedicine / Q000458:organization & administration*; D013689:Telephone