Testing Pediatric Emergency Telemedicine Implementation Strategies Using Quality Improvement Methods

• Published in: Telemedicine journal and e-health Vol. 27; no. 4; p. 459
• Main Authors: Rosenthal, Jennifer L, Sauers-Ford, Hadley S, Snyder, Moina, Hamline, Michelle Y, Benton, Angela S, Joo, Sharon, Natale, JoAnne E, Plant, Jennifer L
• Format: Journal Article
• Language: English
• Published: United States 01.04.2021
• Subjects: Child; Emergencies; Emergency Service, Hospital; Humans; Quality Improvement; Retrospective Studies; Telemedicine; hospitals; telemedicine; health care transitions; patient transfers; emergency service; quality improvement; referral and consultation; communication; hospital; child; pediatric
• ISSN: 1556-3669
• DOI: 10.1089/tmj.2020.0067

Despite the recognized benefits of telemedicine use for pediatric emergency consultations, there are barriers to the widespread uptake of this technology. Quality improvement methods can be used to rapidly test implementation strategies. Our objective was to test telemedicine implementation strategies in real-world application using quality improvement methods. Our quality improvement aim was to achieve high rates of telemedicine use for pediatric transfer consultations. A multidisciplinary multisite improvement team identified that key drivers of increasing telemedicine use included telemedicine resource awareness, streamlined telemedicine workflow, provider buy-in, and data transparency. Interventions focused on telemedicine trainings, disseminating telemedicine uptake data, telemedicine reminders, telemedicine test calls, and preparing for telemedicine use for every transfer consultation. The outcome measure was percentage of pediatric emergency transfer consultations that used telemedicine. The balancing measure was time (minutes) from the initial transfer center call to completion of the consultation. Multiple plan-do-study-act cycles were associated with special cause variation, with an upward shift in mean percentage of telemedicine use from 5% to 22%. Time from initial call to consultation completion remained unchanged. Our study supports the use of quality improvement methods to test telemedicine implementation strategies for pediatric telemedicine emergency consultations.