Clinical trial NCT02915640: Use of a Mobile Remote Device to Optimize Pediatric Inter-facility Transportation: A Feasibility Study
Official title: Remote Technology for Paediatric Patient Assessment, Stabilization and Triaging Prior to Paediatric Inter-facility Transportation: A Feasibility Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Acute Disease
Lead sponsor: University of Saskatchewan
Sponsor class: OTHER
First posted: 2016-09-27
Enrollment: 69
Sex: ALL
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study compares the utilization of remote technology versus not using remote technology when triaging and managing pediatric patients in remote settings prior to pediatric specialized inter-facility transportation.

Detailed description: Paediatric Specialized Inter-facility transport utilizes specialized teams usually made up of a respiratory therapist, paediatric critical care nurse, and paediatric intensivist as medical control. When a Nurse Practitioner or General Practitioner from a remote site has a paediatric acute care referral and wants to arrange transportation there is an initial call at which point there are two priorities: first is obtain a patient history and then provide advice to the remote caregiver to initiate specific therapies; second is to mobilize the specialized team to the patient. The period of time between giving initial advice while dispatching the team and the time when the team arrives, can often be a vulnerable period for the remote caregiver as well as the patient. The ability to directly visualize and assess the patient during this time, as well as assist the specialized team once they arrive may provide improvement in safety and care of the patient. It may also improve triaging and may make the stabilization and departure time more efficient.

Remote technology will be used for an initial patient assessment after being contacted by phone from the peripheral centre to transfer an acutely ill paediatric patient as assessed by the referral centre care provider. After assessment the patient will be triaged to either remain in the local community, transferred to a regional hospital that provides paediatric acute care (Prince Albert), or be transported to Royal University Hospital in Saskatoon for tertiary care. Data to be collected includes:

* Duration of time from the beginning of the initial phone call to the first therapeutic intervention
* Time to stabilization
* Time to decision for disposition
* The duration of contact with the health care provider and the patient
* Number of scheduled follow-up contacts for a specific patient within 24 hours
* Number of times the referring centre re-consults
* Of the patients who triaged to stay in the local community how many were transported to the tertiary care centre within 24hrs
* How many patients who arrived at the tertiary care centre were discharged within 24hrs
* How many patients on arrival were deemed to be unnecessary

The nurses and physicians who are communicating with the Intensivist about the case will complete a post-encounter survey to evaluate their experience.

Eligibility criteria: Remote Technology Group Inclusion:

* Patients ≤ 17 years from peripheral centre (Pelican Narrows Clinic and Regina General Hospital).
* Acutely ill.
* Being considered for medical transport.

Control Group Inclusion:

* Patients ≤ 17 years from peripheral centre (Stony Rapids, Wollaston Lake and Sandy Bay).
* Chosen from a pre-existing Saskatchewan paediatric transport database.

Exclusion Criteria:

* Patients older than age 17.

Primary outcomes:
measure: Transport number in the cases (with the robot) versus the controls (without the robot)
timeFrame: One year
Secondary outcomes:
measure: Tertiary care hospital length of stay in the cases versus the controls
timeFrame: One year
measure: The number of patients transported to the regional hospitals in the cases (with the robot) versus the controls (without the robot)
timeFrame: One year
Other outcomes:
Locations:
city: Pelican Narrows
country: Canada
facility: Pelican Narrows Clinic (Angelique Canada Health Centre)
state: Saskatchewan
city: Regina
country: Canada
facility: Regina General Hospital
state: Saskatchewan
city: Saskatoon
country: Canada
facility: Royal University Hospital
state: Saskatchewan
Study officials:
affiliation: Clinical Assistant Professor
name: Tanya Holt, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, Kuch BA, Watson RS. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009 Jul;124(1):40-8. doi: 10.1542/peds.2008-0515.
citation: Stroud MH, Prodhan P, Moss MM, Anand KJ. Redefining the golden hour in pediatric transport. Pediatr Crit Care Med. 2008 Jul;9(4):435-7. doi: 10.1097/PCC.0b013e318172da62.
citation: Borrows EL, Lutman DH, Montgomery MA, Petros AJ, Ramnarayan P. Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport. Pediatr Crit Care Med. 2010 Jul;11(4):451-6. doi: 10.1097/PCC.0b013e3181e30ce7.
citation: Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003 Oct;112(4):793-9. doi: 10.1542/peds.112.4.793.
citation: Mendez I, Song M, Chiasson P, Bustamante L. Point-of-Care Programming for Neuromodulation: A Feasibility Study Using Remote Presence. Neurosurgery. 2013 Jan;72(1):99-108; discussion 108. doi: 10.1227/NEU.0b013e318276b5b2.
citation: Rothenberg SS, Yoder S, Kay S, Ponsky T. Initial experience with surgical telementoring in pediatric laparoscopic surgery using remote presence technology. J Laparoendosc Adv Surg Tech A. 2009 Apr;19 Suppl 1:S219-22. doi: 10.1089/lap.2008.0133.supp.