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Acad Pediatr. 2020 Feb 26. pii: S1876-2859(20)30085-1. doi: 10.1016/j.acap.2020.02.028. [Epub ahead of print]

Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments through Telemedicine.

Author information

1
Department of Pediatrics, Northwestern Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL 60611; Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 86, Chicago, IL 60611; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, 680 North Lake Shore Drive, Chicago, IL 60611; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: ccfoster@luriechildrens.org.
2
Department of Pediatrics, Northwestern Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL 60611; Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, 680 North Lake Shore Drive, Chicago, IL 60611; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611; Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: mmacy@luriechildrens.org.
3
Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: nsimon@luriechildrens.org.
4
Department of Pediatrics, Northwestern Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL 60611; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611; Hospital-Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: rstephen@luriechildrens.org.
5
Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: klehnig@luriechildrens.org.
6
Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: kbohling@luriechildrens.org.
7
Department of Pediatrics, Northwestern Feinberg School of Medicine, 225 E. Chicago Avenue, Chicago, IL 60611; Telehealth Programs, Lurie Children's, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611; Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611. Electronic address: dschinasi@luriechildrens.org.

Abstract

Increasingly, children with common and lower-acuity conditions are being transferred from general emergency departments (EDs) to pediatric centers for subspecialty care. While transferring children with high-risk conditions has benefit, transferring children with common conditions may expose them to redundant care and added costs. Emergency Care Connect (ECC) is a novel telemedicine program that uses videoconferencing to connect general ED and urgent care providers to pediatric emergency medicine physicians with the goal of keeping children in their communities for definitive care, when safe and feasible. ECC objectives are to: 1) facilitate transfer decision-making for children receiving care in general ED and urgent care sites and 2) increase access to pediatric providers for real-time management, regardless of disposition. In its first 20 months, ECC partnered with four general EDs and one urgent care location, which together made 1,327 contacts with our pediatric center, of which 202 (15%) became ECC consultations for 200 unique patients. Of those consultations, 71% patients remained locally for treatment and 25% experienced a care plan change. Overall, ECC was rated highly by surveyed families and providers. Barriers to implementation, such as lack of familiarity with telemedicine and fears of changes in workflow, were overcome with strong institutional support and frequent, sustained stakeholder engagement. With greater adoption of this model, ECC and programs like it have the potential to allow more children to be treated in their communities, minimize preventable transfers, and reserve beds in children's hospitals for those with potentially higher-risk and more medically complex conditions.

KEYWORDS:

Pediatric emergency medicine; access to care; emergency department; telehealth; telemedicine

PMID:
32112864
DOI:
10.1016/j.acap.2020.02.028

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