Evaluating the feasibility and impact of a synchronous health technology innovation in the provision of pediatric health care in a University Hospital.

Delivering critical and speech-language pathology care in pediatric settings requires much hard work to reach the desired level of care for children. Several factors contribute to this problem, including resources shortage, pressing needs, and the growing number of ill children. Among the proposed solutions, many believe that synchronous telemedicine can play a role by providing virtual and immediate access to remote skills, with expertise could be made instantly available through a platform that allows efficient communication and is able to support pediatric care. Telemedicine has developed significantly in the provision of critical care and pediatric rehabilitation in terms of diagnosis and therapy. Yet, few studies have examined the feasibility and evaluated the impact of telemedicine on the quality of pediatric critical care and rehabilitation. The main objective of this dissertation was to assess the feasibility of synchronous telemedicine in two pediatric settings—critical care and rehabilitation—and to evaluate its influence on the process of providing pediatric care. The first article presented the results of a systematic review that synthesized studies evaluating the impacts of synchronous telemedicine models on clinical outcomes in pediatric acute care settings. The findings revealed that the use of synchronous telemedicine improved quality of care and resulted in a lower transfer rate, a shorter length of stay, a change in or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital standardized mortality rate. However, the review of the state of knowledge revealed that the quality of the included studies was weak, so more high-quality evidences is needed. The second article, which used a pre/post design, assesses the feasibility assessed the feasibility of home-based telepractice in speech-language pathology (TSLP) and its impact on satisfaction among the children and speech-language pathologists, economic cost, and voice performance. This study showed that TSLP is feasible and that both the children and the speech-language pathologists were satisfied with the service. In addition, the use of TSLP demonstrated more voice improvement at less cost to the parents. The third article evaluated the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). For a STEP-PICU to be feasible and truly helpful, it needs good preparation for the implementation of the telemedicine solution. With competent and autonomous fellows (a fellow is a physician who has completed their residency and elects to complete further training in a subspecialty), the usefulness of an synchronous telemedicine (STM) platform linking off-site pediatric intensivists and on-site fellows in a PICU is limited. This study added that such a service could be more beneficial than the traditional model of care (face to face) for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist. These three studies allow us to conclude that STM is feasible and can have an impact on the quality of pediatric intensive care and rehabilitation. This thesis underscores the importance of taking into consideration the context in which the technology will be implemented. Treating the PICU and the rehabilitation contexts in the same way does not lead to the same results, and a technological innovation that succeeds in one setting may fail in another.

Keyphrases: Fellows, Synchronous telemedicine, Telehealth, e-health, Pediatric intensive care, Critical care, Acute care, Systematic review, Clinical outcomes, Fellows, Speech-language pathologists, Voice performance