Jjais Richards, MD
PCCM Fellow
Johns Hopkins All Childrens Hospital
St Petersburg, Florida
Disclosure information not submitted.
Anthony Sochet, MD, MS
Assistant Professor, Anesthesiology and Critical Care Medicine
Johns Hopkins All Childrens Hospital
St Petersburg, Florida
Disclosure information not submitted.
Jessie Hoang, MD
Assistant Clinical Instructor
Florida State University College of Medicine, United States
Disclosure information not submitted.
Ladonna Bingham, MD
Assistant Professor, Anesthesia and Critical Care Medicine
Johns Hopkins All Children's Hospital, United States
Disclosure information not submitted.
Title: Pediatric Critical Care Medicine Teleconsultation: A Qualitative Perceptions Analysis
Introduction: Nearly 15% of children in the United States live >41 miles from pediatric critical care medicine (PCCM) services. PCCM-teleconsultation (TC) may address potential healthcare access disparities. We sought to describe provider perceptions of PCCM-TC and determine if differences exist by specialty (PCCM vs. pediatric hospital medicine [PHM]).
Methods: We performed a prospective, mixed methods study from June - July 2021 via survey data from interdisciplinary clinicians from a quaternary pediatric referral center and a community-based referring facility. Primary outcomes included respondent characteristics, perceptions of PCCM-TC, and ranked diagnoses that may prompt future PCCM-TC. Our survey, adapted from the literature, collected non-parametric Likert scales, proportions, and free-text responses. Data extracted from an electronic data capture system was summated using Stata v15.1. Responses from PMH and PCCM providers were compared using Wilcoxon rank-sum and chi-square tests.
Results: Of 112 respondents, 44% were nurses, 26% physicians, 20% RTs, 4% pharmacists, and 4% advanced practice providers. Respondent specialties were 27% PCCM, 35% emergency medicine, 34% PHM, and 4% transport medicine. Only 26% reported prior telemedicine exposure and 6% PCCM-TC. Respondents felt they had the necessary skills and knowledge to manage critically ill children (77% - agree/strongly agree), with variation in confidence by specialty (93% PCCM vs. 75% PHM, p< 0.01). Respondents were positive regarding PCCM-TC utility (54% agree/strongly agree, 38% neutral) and reported PCCM-TC may enhance timely transfers or improve local management (60% agree/strongly agree, 32% neutral). If PCCM-TC were available, 32% of PHM respondents expected weekly to monthly use. Ranked diagnoses for PCCM-TC were: respiratory failure, asthma, bronchiolitis, seizures, diabetes, sepsis, and altered mentation. Diagnoses did not vary by respondent specialty or profession.
Conclusions: These data are the first to assess PCCM and PHM provider perceptions of PCCM-TC and are favorable regarding its utility and expected use if available. Common diagnoses suggested by both PHM and PCCM respondents may represent ideal simulation or didactic scenarios for PCCM-TC training geared towards optimizing consultant performance and end-user experience.