title: Pediatric Critical Care Telemedicine Program: A Single Institution Review.
abstract: BACKGROUND
  Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care.
  
  
  METHODS
  We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided.
  
  
  RESULTS
  During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%).
  
  
  CONCLUSIONS
  This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.
authors.affiliation: 1 Department of Psychology, University of Southern California , Los Angeles, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: 2 Center for Health and Technology, University of California Davis Health System , Sacramento, California.
authors.forename: Nayla
authors.initials: N
authors.lastname: Hojman
authors.affiliation: 2 Center for Health and Technology, University of California Davis Health System , Sacramento, California.
authors.forename: Candace
authors.initials: C
authors.lastname: Sadorra
authors.affiliation: 2 Center for Health and Technology, University of California Davis Health System , Sacramento, California.|3 Department of Pediatrics, University of California Davis School of Medicine , Sacramento, California.
authors.forename: Madan
authors.initials: M
authors.lastname: Dharmar
authors.affiliation: 4 Department of Family and Community Medicine, University of California Davis School of Medicine , Sacramento, California.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.affiliation: 2 Center for Health and Technology, University of California Davis Health System , Sacramento, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Litman
authors.affiliation: 2 Center for Health and Technology, University of California Davis Health System , Sacramento, California.|3 Department of Pediatrics, University of California Davis School of Medicine , Sacramento, California.
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000458:organization & administration*; D003422:Critical Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000458:organization & administration*; D019114:Remote Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*
keywords: behavioral health; e-health; mobile health; technology; telehealth