Impact of telemedicine on visit attendance for paediatric patients receiving endocrinology specialty care

2020 ◽  
pp. 1357633X2097291
Author(s):  
Sarah C Haynes ◽  
James P Marcin ◽  
Parul Dayal ◽  
Daniel J Tancredi ◽  
Stephanie Crossen
Keyword(s):  
Rural Communities ◽  
Demographic Data ◽  
Academic Medical Centre ◽  
Medical Diagnoses ◽  
Paediatric Patients ◽  
Academic Medical ◽  
Paediatric Endocrinology ◽  
Publicly Insured ◽  
Improve Access ◽  
Paediatric Endocrinologist

Background Children in rural communities often lack access to subspecialty medical care. Telemedicine has the potential to improve access to these services but its effectiveness has not been rigorously evaluated for paediatric patients with endocrine conditions besides diabetes. Introduction The purpose of this study was to assess the association between telemedicine and visit attendance among patients who received care from paediatric endocrinologists at an academic medical centre in northern California between 2009–2017. Methods We abstracted demographic data, encounter information and medical diagnoses from the electronic health record for patients ≤18 years of age who attended at least one in-person or telemedicine encounter with a paediatric endocrinologist during the study period. We used a mixed effects logistic regression model – adjusted for age, diagnosis and distance from subspecialty care – to explore the association between telemedicine and visit attendance. Results A total of 40,941 encounters from 5083 unique patients were included in the analysis. Patients who scheduled telemedicine visits were predominantly publicly insured (97%) and lived a mean distance of 161 miles from the children’s hospital. Telemedicine was associated with a significantly higher odds of visit attendance (odds ratio 2.55, 95% confidence interval 2.15–3.02, p < 0.001) compared to in-person care. Conclusions This study demonstrates that telemedicine is associated with higher odds of visit attendance for paediatric endocrinology patients and supports the conclusion that use of telemedicine may improve access to subspecialty care for rural and publicly insured paediatric populations.

TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers

2021 ◽  
pp. 1357633X2110381
Author(s):  
Jawahar Jagarapu ◽  
Vishal Kapadia ◽  
Imran Mir ◽  
Venkat Kakkilaya ◽  
Kristin Carlton ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Demographic Data ◽  
Newborn Infants ◽  
Cost Savings ◽  
Neonatal Care ◽  
Transport Cost ◽  
Medical Diagnoses

Background The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. Objective To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. Materials and methods We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. Results TeleNICU had one hub (Level IV) and nine spokes (Levels I–III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). Conclusion Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.

scholarly journals Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital

2021 ◽  
pp. 197140092098866
Author(s):  
Daniel Thomas Ginat ◽  
James Kenniff
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
The United States ◽  
Radiology Department ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
The Impact

Background The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown. Methods Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests. Results Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown. Conclusion The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.

scholarly journals Where is the leak in the pipeline? Investigating gender differences in academic promotion at an academic medical centre

2016 ◽  
Vol 5 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Jessica K. Paulus ◽  
Karen M. Switkowski ◽  
Geneve M. Allison ◽  
Molly Connors ◽  
Rachel J. Buchsbaum ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Academic Promotion ◽  
Academic Medical

scholarly journals Speaking up about care concerns in the ICU: patient and family experiences, attitudes and perceived barriers

2018 ◽  
Vol 27 (11) ◽  
pp. 928-936 ◽  
Author(s):  
Sigall K Bell ◽  
Stephanie D Roche ◽  
Ariel Mueller ◽  
Erica Dente ◽  
Kristin O’Reilly ◽  
...  
Keyword(s):  
Perceived Barriers ◽  
Family Education ◽  
Speaking Up ◽  
Academic Medical Centre ◽  
Know How ◽  
Family Attitudes ◽  
Conflicting Information ◽  
Academic Medical ◽  
Internet Sample ◽  
Speak Up

BackgroundLittle is known about patient/family comfort voicing care concerns in real time, especially in the intensive care unit (ICU) where stakes are high and time is compressed. Experts advocate patient and family engagement in safety, which will require that patients/families be able to voice concerns. Data on patient/family attitudes and experiences regarding speaking up are sparse, and mostly include reporting events retrospectively, rather than pre-emptively, to try to prevent harm. We aimed to (1) assess patient/family comfort speaking up about common ICU concerns; (2) identify patient/family-perceived barriers to speaking up; and (3) explore factors associated with patient/family comfort speaking up.MethodsIn collaboration with patients/families, we developed a survey to evaluate speaking up attitudes and behaviours. We surveyed current ICU families in person at an urban US academic medical centre, supplemented with a larger national internet sample of individuals with prior ICU experience.Results105/125 (84%) of current families and 1050 internet panel participants with ICU history completed the surveys. Among the current ICU families, 50%–70% expressed hesitancy to voice concerns about possible mistakes, mismatched care goals, confusing/conflicting information and inadequate hand hygiene. Results among prior ICU participants were similar. Half of all respondents reported at least one barrier to voicing concerns, most commonly not wanting to be a ‘troublemaker’, ‘team is too busy’ or ‘I don’t know how’. Older, female participants and those with personal or family employment in healthcare were more likely to report comfort speaking up.ConclusionSpeaking up may be challenging for ICU patients/families. Patient/family education about how to speak up and assurance that raising concerns will not create ‘trouble’ may help promote open discussions about care concerns and possible errors in the ICU.

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