NEW HOME-TO-HOSPITAL CONNECTED CRITICAL CARE PROGRAM AT MASS GENERAL’S PEDIATRIC INTENSIVE CARE UNIT PUTS ATTENDING DOCTORS AT PATIENT BEDSIDE 24/7
The eleven-year-old girl – for privacy we will call her Michele – was admitted to the MassGeneral Hospital Pediatric Intensive Care Unit (PICU) at 2:00 am with respiratory distress. The on-call attending physician evaluated Michele, identified her respiratory failure and discussed treatment with a nurse, a PICU fellow and a respiratory therapist at the patient’s bedside. He addressed the mother’s concerns and supervised Michele’s treatment.
Though similar scenes are played out in hospitals every day, this one was unique. The on-call attending physician was at home before, during and after the episode.
An innovative program has been launched by MassGeneral Hospital for Children (MGHfC) and the Partners Center for Connected Health (CCH). It places home telehealth equipment into the homes of pediatricians to allow them to immediately respond to the needs of patients in the hospital’s
Pediatric Intensive Care Unit (PICU).
“These children often require ongoing and around-the-clock assessment and care management, coordinated among a team of residents, fellows, nurses, respiratory therapists and attending physicians,” a Partners CCH news release explained. “A new, pioneering home-to-hospital program, Connected Pediatric Critical Care, features real-time video communication, enabling the on-call attending physician, when at home, to personally examine the patient and communicate directly with the PICU staff, other specialists and even the child’s parents.”
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Six PICU physicians from MGHfC now have videoconferencing units in their homes. When they are needed for a consult in the middle of the night or on weekends, they videoconference in to a portable telemedicine station positioned at the patient’s bedside. The attending physician can then see the patient, talk with clinicians on-site, personally evaluate the child’s condition and make treatment decisions. Special cameras and scopes can also be attached to the hospital-based unit to allow for closer evaluation of the young patient.
“Since launching this program in May, we are already seeing that the Connected Pediatric Critical Care program is significantly improving the quality of care, team communication and staff responsiveness during evening hours and weekends when our attending physicians, ultimately responsible for patient care, have left the hospital to go home,” said Natan Noviski, MD, chief, Pediatric Critical Care Medicine, MassGeneral Hospital for Children. “Because the attending physician can remotely examine the patient and communicate with the on-site staff directly, decision making can be enhanced and the quality of care improved.”
Overnight and weekends, on-call attending physicians were traditionally contacted via telephone by the covering fellow or resident in the PICU. The attending physician would provide guidance, via telephone, without input from the rest of the team and without personally seeing the patient. The attending would then decide if it was necessary to return to the hospital.
“Videoconferencing is not new, but the application of this technology – connecting at-home physicians with their patients and the hospital-based medical team – is a novel and important advance in critical care medicine,” added Joseph C. Kvedar, MD, director, Center for Connected Health. “We anticipate that other intensive care units, for both adult and pediatric patients, could benefit as well.”
The Connected Pediatric Critical Care program also creates a more robust teaching opportunity, allowing residents to be more involved in the team approach essential in an intensive care environment. Importantly, parents also feel more confident in their child’s care and more connected to the treating physician, giving parents the opportunity to interact directly with the attending doctor at home.
According to a study published in Pediatrics (1998; 102 (5); e58), the use of connected health to assess sick children has been shown to have both a high sensitivity (ability of the remote physician to detect abnormal findings) and a high specificity (ability of the remote physician to detect normal findings). For example, the observations of a remote pediatric critical care medicine physician matched those made by a pediatric emergency room physician 97% of the time. Assessment of physical signs requiring direct visualization, such as neurological status, made by the remote physician and the on-site emergency room doctor, were the same in 100% of the cases.
About the Center for Connected Health
The Center for Connected Health, a division of Partners HealthCare, is creating new ways to deliver quality patient care outside of the traditional medical setting. Programs use a combination of remote-monitoring technology, sensors, and online communications and intelligence to improve patient adherence, engagement and clinical outcomes. The Center also offers expert, online second opinions, enhanced medical education and training and engages in research to discover new pathways to better care, including the use of virtual worlds and online coaching.
About the Massachusetts General Hospital
Founded in 1811, MassGeneral is the third oldest general hospital in the United States and the oldest and largest in New England. The 900-bed medical center admits more than 46,000 inpatients per year and handles nearly 1.5 million outpatient visits at its main campus and health centers. Its Emergency Department records nearly 80,000 visits annually. MassGeneral conducts the largest hospital-based research program in the country, with an annual research budget of more than $500 million. It is the oldest and largest teaching hospital of Harvard Medical School, where nearly all MGH staff physicians serve on the faculty.
