PC1266: Implementing Telehealth and Image Exchange to Create a Virtual Pediatric Trauma Center

Background: Under PCORI funds, we’ve begun an evaluation of a “virtual pediatric trauma center” (VPTC) where pediatric trauma, orthopedic, and neurosurgery providers use videoconferencing and image sharing to initiate care of children remotely in a receiving hospital emergency department (ED). The study’s goal is to compare the current standard-of-care to the VPTC model of care with regards to the parent/family experience of care, parent/family distress, healthcare utilization, and out-of-pocket cost burden. Study enrollment began in November 2020 and will continue until November 2022. In this abstract, we report our implementation, operations, and lessons learned in implementing the VPTC.

Methods: Study aims are to compare the current standard-of-care to the VPTC model of care regarding: 1) parent/family experience of care and distress 3, 30, 60 and 90 days following a childhood injury; 2) 30-day healthcare utilization following the injury event; 3) out-of-pocket costs and financial burdens experienced by parents/families 3-days and 30-days following the injury and ED visit to a non-pediatric trauma center. We implemented a stepped-wedge design among a selection of 10 EDs in Northern California, with a goal of enrolling 380 patients by November 2022. To operationalize this, we deployed image sharing technologies, pole-mounted videoconferencing units with high-definition monitors, omnidirectional microphones, and remote-controlled pan-tilt-zoom 15x optical zoom cameras. Providers at the VPTC were provided access to workstations and video capable mobile devices.

Results: To date, 228 pediatric trauma patients are enrolled. Adherence for videoconferencing has occurred in 74 of 169 (44%) eligible patients; image sharing has occurred in 61 of 151 (40%) eligible patients. Collection rates of surveys of parent/family experience of care, distress, and financial burden surveys has been 59%. The protocol relies on the Trauma Nurse Practitioners to administer telehealth recommendations. Workflow process changes were made to increase reliability, fidelity of the intervention, and data collection through meetings. Adaptations include paging the telehealth provider directly, meeting with partner hospital IT focused on remote image sharing, automating text message reminders sent to the transfer center staff, and inclusion of a smart phrase into transfer staff intake notes. The last six months intervention shows adherence for telehealth increased from 29% to 44% and remote image sharing increased from 25% to 40%.

Conclusion: Implementing telehealth and image sharing to deliver acute pediatric trauma care is challenging. Challenges include incorporating videoconferencing and integrating platforms at partner sites. Implementing telehealth and image sharing into existing workflows and obtaining “buy-in” from several specialty teams is an investment in culture change. However, acutely injured children can receive regionalized pediatric trauma expertise in a receiving hospital ED. Current findings illustrate the need for qualitative data to improve family experience. We will interview providers and families to evaluate the clinical workflow and telehealth experience for acute trauma care.