title: Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation.
abstract: OBJECTIVE
  Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial.
  
  
  METHODS
  In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia.
  
  
  RESULTS
  The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at community hospitals is warranted.
authors.affiliation: From the *Children's Respiratory and Critical Care Specialists, Minneapolis, MN; †Departments of Anesthesiology and Critical Care Medicine and ‡Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD; §Division of Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA; and ∥Divisions of Critical Care Medicine and Anesthesiology and Pain Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Yang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.forename: Nicole
authors.initials: N
authors.lastname: Shilkofski
authors.forename: Robert
authors.initials: R
authors.lastname: Dudas
authors.forename: Chinyere
authors.initials: C
authors.lastname: Egbuta
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Schwartz
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000628:therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000628:therapy*; D000070856:High Fidelity Simulation Training / Q000379:methods; D006764:Hospitals, Community; D006801:Humans; D012017:Referral and Consultation; D017216:Telemedicine / Q000379:methods*