Use of a Mobile Remote Device to Optimize Pediatric Inter-facility Transportation: A Feasibility Study

Acute Disease Clinical Trial

Official title:

Remote Technology for Paediatric Patient Assessment, Stabilization and Triaging Prior to Paediatric Inter-facility Transportation: A Feasibility Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02915640
• Other study ID #: PITROBOT-1
• Status: Completed
• Phase: N/A
• First received: September 21, 2016
• Last updated: September 26, 2016
• Start date: March 2015
• Est. completion date: May 2016

Study information

• Verified date: September 2016
• Source: University of Saskatchewan
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 69
• Est. completion date: May 2016
• Est. primary completion date: February 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A to 17 Years

Eligibility

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.

Study Design

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Acute Disease

Intervention

Other:
• Remote technology
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.

Locations

Country	Name	City	State
Canada	Pelican Narrows Clinic (Angelique Canada Health Centre)	Pelican Narrows	Saskatchewan
Canada	Regina General Hospital	Regina	Saskatchewan
Canada	Royal University Hospital	Saskatoon	Saskatchewan

Sponsors (1)

Lead Sponsor	Collaborator
University of Saskatchewan

Country where clinical trial is conducted

Canada, 

References & Publications (6)

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. — View 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. Review. — View 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. — View 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. — View 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. — View 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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Transport number in the cases (with the robot) versus the controls (without the robot)		One year	No
Secondary	Tertiary care hospital length of stay in the cases versus the controls		One year	No
Secondary	The number of patients transported to the regional hospitals in the cases (with the robot) versus the controls (without the robot)		One year	No