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Pitt-UPMC Program Guides Expansion of Telemedicine Use in Pediatric Emergencies

PITTSBURGH, March 1, 2013 – When a child ends up in an emergency room at one of Pennsylvania’s rural hospitals, the emergency doctor has a tough decision to make – treat the child there with limited pediatric expertise or send him or her to Children’s Hospital of Pittsburgh of UPMC, often hundreds of miles from home.
A new University of Pittsburgh Schools of the Health Sciences project will use telemedicine to make the decision easier. On Monday, March 4, a team of doctors, scientists and emergency, pediatric and rural health officials will  launch “Optimizing Utilization and Rural Emergency Access for Children,” or OUTREACH, a project designed to make telemedicine more effective in pediatric emergencies.
“About a quarter of all pediatric emergency visits are to hospitals in rural areas, yet these hospitals rarely possess the equipment, experience and expertise necessary to provide effective emergency care to children,” said  Jeremy Kahn, M.D., M.S., project leader and associate professor of critical care, medicine and health policy at Pitt’s School of Medicine and Graduate School of Public Health. “Our goal is to make it quick and easy for rural emergency doctors to consult with pediatric specialists at UPMC to determine the best treatment plan for each child.”
The project is paid for with a nearly $1 million grant from the U.S. Department of Health and Human Services Health Resources and Services Administration. It is designed to address critical deficiencies in pediatric emergency care reported in the
Institute of Medicine’s “Emergency Care for Children: Growing Pains.”
Dr. Kahn and his team will interview hospital administrators, physicians, nurses, emergency transport personnel, patients and families to identify issues surrounding pediatric emergency care and potential obstacles to using telemedicine in rural hospitals.
That information will then be used to craft a standardized educational program to help these hospitals best use telemedicine to improve pediatric emergency care through consultations with Children’s Hospital of Pittsburgh specialists. The team will then partner with the Pennsylvania Department of Public Welfare, which oversees the state’s Medicaid program, to evaluate the effects of the program.
If successful, the program could be used as a model for pediatric emergency care nationwide.
“Our goal is to reduce unnecessary transfers while providing the same level of world-class service using telemedicine that our patients receive when they come directly to the Children’s campus,” said Harun Rashid, vice president of global health services and chief information officer at Children’s Hospital.
Kobe Long, 2, of Washington in Washington County, has cerebral palsy and has been helped twice in the last year by telemedicine. Both times involved breathing problems for which Kobe’s mother, Christa Bolen, had taken him to Washington Hospital.
“Having the doctors examine him with telemedicine was different – but very easy,” she said. “You didn’t have to try to explain what was happening over the phone. The doctors at Children’s could see for themselves and decide on the best treatment.”
In Kobe’s case, the doctors determined that he needed to be flown by medical helicopter to Children’s Hospital, where they were able to quickly intubate him and stabilize his breathing.
In addition to improving care and saving lives, the program could cut down on unnecessary travel for children and their families, as well as reduce medical costs.
“There is an inherent value in keeping a sick or injured child in his or her community when possible,” Dr. Kahn said. “They can recover with their family and friends close by and avoid excessive disruption to their family’s routine.”
In the last year, more than 400 children were transferred from a rural emergency department to Children’s Hospital of Pittsburgh – a journey that can involve several hours of travel time – only to be immediately discharged back to their communities. If these children were triaged via telemedicine, $800,000 could have been saved, according to data collected from the Children’s Hospital Emergency Department.
Initially, the OUTREACH program will be in five rural hospitals: UPMC Northwest Hospital in Seneca, Venango County; UPMC Horizon Hospital in Farrell, Mercer County; Washington Hospital in Washington, Washington County; Armstrong County Memorial Hospital in Kittanning, Armstrong County; and DuBois Regional Medical Center in DuBois, Clearfield County.
More hospitals will be recruited as the project progresses.
A key component to the OUTREACH program is an in-depth plan to evaluate its impact on health care access, mortality rates, injury rates and health care costs.
“Our intent is to provide unbiased data on the program’s accomplishments to inform efforts to replicate system-wide emergency care improvements in other areas,” Dr. Kahn said.

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