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Verification Reqs SPROUT ECHO 01.29.2024 FINAL

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The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AAP designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity is acceptable for a maximum of 6.0 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

PAs may claim a maximum of 6.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

MOC Statement:

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 5.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.

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Robinn Yu
Program Manager, ECHO Initiatives
ryu@aap.org

Lauren Barone
Director, Primary Care & Workforce
lbarone@aap.org

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Christina Olson, MD, FAAP
Children's Colorado

Jennifer Fang, MD, MS, FAAP
Mayo Clinic

Jennifer Rosenthal, MD, FAAP
University of California Davis

Jordan Vaughn, MD, FAAP
University of California San Francisco

Ken Tegtmeyer, MD, FAAP, FCCM
Cincinnati Children's Hospital Medical Center

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 2. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 2. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 3. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 3. After registering, you will receive a confirmation email about joining the meeting.

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Session 4 - December 13, 2023 11am - 12pm CT

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Session 4 - December 13, 2023 11am - 12pm CT

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 4. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 4. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 5. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 5. After registering, you will receive a confirmation email about joining the meeting.

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Session 6 - February 14, 2023 11am - 12pm CT

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Session 6 - February 14, 2023 11am - 12pm CT

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 6. After registering, you will receive a confirmation email about joining the meeting.

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Welcome! You are invited to join a meeting: SPROUT Teleinpatient ECHO Session 6. After registering, you will receive a confirmation email about joining the meeting.

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Session 1 - September 13, 2023 11am-12pm CT

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Session 1 - September 13, 2023 11am-12pm CT

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SPROUT Telehealth Research Network Website

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SPROUT Telehealth Research Network Website

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​

SPROUT is a multicentered collaborative research network dedicated to establishing an evidence base for pediatric telehealth.

Our Vision

Children receive the best healthcare: Anywhere, Anytime

Our Mission

Promote, develop, and disseminate multicenter value-driven research on pediatric telehealth

Our Values

Studies conducted and promoted by SPROUT are:

Our Objectives:

Create telehealth research frameworks and resources

Provide platforms for dissemination and education of research resources

Promote interdisciplinary and interprofessional multisite telehealth research to target gaps in the current telehealth evidence base and

Maintain a Telehealth Research Database

Executive Committee:

John Chuo MD, MS, IA, FAAP, Children's Hospital of Philadelphia
Alison Curfman MD, MBA, FAAP, Imagine Pediatrics
Christina Olson MD, FAAP, Children's Hospital Colorado
S. David McSwain MD, MPH, FAAP, UNC Health

Telehealth Working Groups (TWGs):

TWGs were created to promote a collaborative and supportive environment to fellow members, including initiating multisite research projects, publications, grant proposals, and IRB submissions.

Currently there are 7 TWGs that are active:
Health Equity
Metrics
Neonatology
Patient-Centered Medical Home
Transport
Telehealth Education

Resources & Tools:

Economic Framework

AAP Tele-Research ECHO Program (2021):
This ECHO, in partnership with the CTSA, uses technology, clinical management tools, and case‐based learning to teach health care and research professionals about telehealth research and virtual tools that support research.

For more information about SPROUT email sprout@aap.org.

Funding:

National Institutes of Health - Grant #U01TR002626
SPROUT-CTSA Collaborative Telehealth Research Network

To get involved, contact us.

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supporting pediatric research on outcomes and utilization of telehealth

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Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT)

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It is the mission of S.P.R.O.U.T. to promote, develop, and disseminate multicenter value-driven research on pediatric telehealth.

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Thank you for participating in the American Academy of Pediatrics SPROUT Tele-inpatient ECHO program. To be sure we are meeting your needs we would appreciate your feedback by answering a few questions about the session that you just attended.

All data collected is anonymous and will not be associated with your name or place of work. Data will be stored on password protected computers and responses will be combined with other participants' responses and reported in aggregate for dissemination.

This survey has been reviewed and approved by the AAP Institutional Review Board (IRB). The risks involved with completing this survey are no greater than the risks a person may find in their daily life. You do not have to answer any question that you do not wish to answer, and you may stop completing the survey at any time.  If you have any questions, please contact Robinn Yu at ryu@aap.org.

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AAP SPROUT Tele-Inpatient ECHO Session 1

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Multicenter study assessing physicians’ and transport teams’ attitudes and expectations about utilizing telemedicine to manage critical neonatal transports

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Multicenter study assessing physicians’ and transport teams’ attitudes and expectations about utilizing telemedicine to manage critical neonatal transports

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The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals

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The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals

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Affiliations

¹ Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif. Electronic address: shaynes@ucdavis.edu.

² Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif.

³ Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif.

⁴ Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif; Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif.

⁵ Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif; Department of Internal Medicine, UC Davis Health (PS Romano), Sacramento, Calif.

⁶ Children's National Health System (JP Marcin), Washington, DC.

Affiliations

¹ Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif. Electronic address: shaynes@ucdavis.edu.

² Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif.

³ Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif.

⁴ Department of Pediatrics, UC Davis Health (SC Haynes, M Dharmar, KR Hoffman, LT Donohue, KM Kuhn-Riordon, CA Rottkamp, P Vali, DJ Tancredi, and JP Marcin), Sacramento, Calif; Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif.

⁵ Center for Healthcare Policy and Research, University of California Davis (BC Hill, DJ Tancredi, and PS Romano), Sacramento, Calif; Department of Internal Medicine, UC Davis Health (PS Romano), Sacramento, Calif.

⁶ Children's National Health System (JP Marcin), Washington, DC.

Abstract

Background and objective: Telemedicine may have the ability to reduce avoidable transfers by allowing remote specialists the opportunity to more effectively assess patients during consultations. In this study, we examined whether telemedicine consultations were associated with reduced transfer rates compared to telephone consultations among a cohort of term and late preterm newborns. We hypothesized that neonatologist consultations conducted over telemedicine would result in fewer interfacility transfers than consultations conducted over telephone.

Methods: We collected data on all newborns who received a neonatal telemedicine or telephone consultation at 6 rural hospitals in northern and central California between August 2014 and June 2018. We used adjusted analyses to compare transfer rates between telemedicine and telephone cohorts.

Results: A total of 317 patients were included in the analysis; 89 (28.1%) of these patients received a telemedicine consultation and 228 (71.9%) received a telephone consultation only. The overall transfer rate was 77.0%. Patient consultations conducted using telemedicine were significantly less likely to result in a transfer than patient consultations conducted using the telephone (64.0% vs 82.0%, P = .001). After controlling for 5-minute Apgar score, birthweight, gestational age, site of consultation, and Transport Risk Index of Physiologic Stability score, the odds of transfer for telemedicine consultations was 0.48 (95% confidence interval: 0.26, 0.90, P = .02).

Conclusions: Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision-making.

Keywords: neonatology; newborns; telemedicine; transfers.

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national center for biotechnology information

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The Impact of Telemedicine on Transfer Rates of Newborns at Rural Community Hospitals - PubMed

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Our findings suggest that telemedicine may have the potential to reduce potentially avoidable transfers of term and late preterm newborns. Future research on potentially avoidable transfers and patient outcomes is needed to better understand the ways in which telemedicine affects clinical decision-m ...

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Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial

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Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial

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Reaching Babies before They Reach the NICU: Launching one of the Nation’s First Neonatal TeleTransport Programs

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Reaching Babies before They Reach the NICU: Launching one of the Nation’s First Neonatal TeleTransport Programs

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When neonates and infants are ill, time is of the essence. That's why Children's Health℠, Children's Medical Center Dallas in collaboration with UT Southwestern recently became one of the nation's first hospitals to launch a neonatal TeleTransport program, enabling our experts to evaluate patients and guide their care, even when they are miles away.
Using TeleTransport, UT Southwestern neonatologists with expertise in Level IV neonatal care can work with the transport team at the outside hospital to assess the patient and their imaging and test results, speak with the referring doctors and parents, and help optimize the baby's condition before transport. Importantly, the virtual connection continues during transport, where the physicians can monitor the patients in real-time and provide minute-by-minute care to keep them as stable as possible.

"TeleTransport allows us to bring Level IV expertise to the patient's bedside at the earliest possible moment," says Vedanta Dariya, M.D., Neonatologist, Director of NICU Transport at Children's Health and Assistant Professor at UT Southwestern. "That's going to help more babies survive and thrive, and our experience building the program could be informative to other hospitals who want to create one of their own."

Tailoring Technology for the Mobile NICU

Dr. Dariya has observed the ever-growing need for technology in NICU care. He recalls one recent case where a critically ill newborn with huge pneumothoraces was being resuscitated at a freestanding ER and then transported to Children's Health.

"I stayed on the phone with the transport team for about 45 minutes," says Dr. Dariya. "And every one of those minutes, I was thinking, 'If I could look at this baby, I wouldn't need to have the transport team telling me what's happening while they're trying to resuscitate the baby.'"

Important hurdles had to be overcome to establish the program. Putting telemedicine on wheels requires light, mobile equipment that doesn't delay transport teams. The technology for both the NICU team and transport nurses has to be extremely user friendly. And TeleTransport equipment has to transmit clear video, audio and telemetry data from medical devices without interruption, even as connectivity fluctuates in rural and urban areas and inside hospitals.

To solve these puzzles, the transport team is equipped with a cellular-enabled tablet, routers in ambulances to provide Wi-Fi hotspots, and software that is simple and intuitive.

"The platform was designed so that, no matter what needs to be done, the nurses and doctors can get to the solution with the smallest number of clicks," says Eric McKenney, I. S. Architect at Children's Health.

Piloting TeleTransport

To pilot the project, transport nurses were trained to use the equipment and incorporate it into their teamwork and their emergency procedures. Early cases showed the difference that the remote connection could make.

The first baby to benefit from TeleTransport had an initial blood gas that was near death. The pH was 6.89, and CO2 was unrecordably high.

The team at Children's Health visually assessed the baby, watched the monitors relaying its vital signs, and collaborated with the transport nurses to change ventilator settings and administer medications - including blood pressure support and nitric oxide - to stabilize the baby's critical condition.

"The team was able to do almost exactly what they would have done if there physically, and when the baby showed up in our NICU four or five hours later, the blood gas was pH 7.40 and PCO2 42, both completely in the normal range," says Dr. Dariya. "All the interventions that were made during the transport improved the baby's physiological condition, and the baby's life was saved."

TeleTransport also allows the physicians and the transport nurses to "meet" the parents virtually. "The transport nurses can engage with the family so that they can understand the specialty care being provided and also meet our physicians who are caring for their baby early in the process," says Scotti Floyd Edgar, Director of Transport Services at Children's Health.

With the first baby TeleTransported, the team at Children's Health was able to counsel the parents as to the critical nature of the baby's condition and keep them updated about the progress being made.

"If parents are able to meet the neonatologist and team virtually before transport," says Kristin Carlton, Program Director for Telespecialty and Clinical Outreach, "when they arrive at Children's Health, they see familiar faces, adding some level of comfort to a very stressful time."

Jumpstarting Therapeutic Cooling

TeleTransport allows Level IV care to start before the babies reach the NICU. One important example is therapeutic hypothermia for babies with hypoxic-ischemic encephalopathy.

"When babies have been severely depressed at birth and deprived of oxygen or blood flow to the brain, their brain is at risk. Hypothermia is the only treatment currently shown to reduce death or disability but only if the encephalopathy is recognized immediately and treatment is initiated in the first six hours after birth - the sooner, the better. Literally speaking, time is brain." says Dr. Lina Chalak, Neonatologist, Director of the Neonatal NeuroNICU Program and Professor at UT Southwestern Medical Center. "We have invested in a Tecotherm Neo device, the only FDA-approved method for cooling on transport, and trained the team on using this fast implementation cooling device as part of the TeleTransport program.

The sooner the cooling begins, the better the baby's chances.

"To determine what babies qualify for this intervention, we need to be able to examine them remotely," says Dr. Dariya. "Then, with certainty, we can tell our transport team, 'Start cooling this baby now.'" The baby can then be actively cooled during transport, starting this critical therapy sooner.

Imagining the Future of TeleTransport

TeleTransport marks the latest milestone in our push to extend Level IV care to babies across our region. In partnership with UT Southwestern, we developed one of the nation's most comprehensive TeleNICU programs in 2013. We've virtually examined more than 200 neonates so far, and more than half of those patients have been able to remain in their home hospitals. Now we're looking for ways to virtually connect with more patients and more providers.

The next goal is to provide TeleTransport capability on "any and every transport," says Dr. Dariya. "And not just for the NICU. My hope is that our colleagues in the ER, Pediatric ICU and CVICU all find benefit doing this. Any service within this hospital should have the ability to evaluate a sick patient - before they get here."

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Reaching Babies before They Reach the NICU: Launching one of the Nation's First Neonatal TeleTransport Programs

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Children's Health and UT Southwestern created an innovative TeleTransport program that accelerates care by helping doctors advise referring physicians.

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Implementation of Telemedicine in Pediatric and Neonatal Transport

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Implementation of Telemedicine in Pediatric and Neonatal Transport

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Abstract

Objective

Telemedicine uses video technology to communicate visual clinical information. This study aimed to implement telemedicine in pediatric and neonatal transport, assess its value, and identify barriers.

Methods

This prospective study implemented telemedicine before transport to a tertiary care children's hospital. A preimplementation survey assessed attitudes toward telemedicine and perceived barriers. During the 12-week pilot, a video connection was initiated between transport and medical control. We collected survey results measuring telemedicine usefulness and hindrance after each use. A postimplementation survey assessed opinions about when telemedicine was useful.

Results

Initially, 82% of users had no direct experience with telemedicine. Perceived utility and burden of telemedicine varied significantly by department. During the study, telemedicine was offered 65% of the time, initiated in 47% of cases, and successful in 30% of cases. The greatest barrier was connectivity. Over time, transport members and physicians found telemedicine to be significantly more useful. In 14 cases, telemedicine changed patient outcome or management. Providers who reported a change in management rated telemedicine as significantly more useful.

Conclusion

This prospective pilot successfully implemented telemedicine before pediatric transport. Telemedicine was more useful in patients with visual findings on examination and, in some cases, changed the clinical outcome.

Section snippets

Methods

The Institutional Review Board of Washington University in St. Louis School of Medicine approved this study and granted a waiver of informed consent.

This was a prospective study at SLCH, a tertiary care referral center for Eastern and Southeastern Missouri and Southern Illinois. The SLCH pediatric transport team averages 180 neonatal and pediatric transports per month. Physicians in the emergency department (ED), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU) and

Preimplementation Survey

The preimplementation survey was completed by 110 of 157 users (70%). Ninety users (82%) had never used telemedicine before this project. Previous use of telemedicine varied across subspecialties from 0 of 15 among hospitalists to 7 of 14 (50%) among NICU providers ( P  = .007). Ratings of expected usefulness and burden also varied significantly by department. Expected usefulness was highest among members of Children's Direct and lowest among the transport team (mean = 4.52 ± 0.61 for Children's

Discussion

Telemedicine holds the potential to address disparities in access to pediatric care, but implementation carries unique challenges. In this prospective study, we incorporated telemedicine into the workflow for pediatric and neonatal transport, described the key barriers to success, demonstrated changes in provider attitudes, and reported cases of change in patient management.

We had to overcome barriers related to individual perceptions and attitudes. Each group of providers in the pediatric

Conclusions

This prospective study successfully implemented telemedicine in pediatric transport and incorporated telemedicine into our workflow. Telemedicine was more useful in cases with visual findings, and in several cases changed management. The implementation and infrastructure barriers in this study are not unique to transport; these challenges must be considered for the development of any telemedicine program. It takes a significant amount of inertia to influence change in our traditionally rigid

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Implementation of Telemedicine in Pediatric and Neonatal Transport

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Telemedicine uses video technology to communicate visual clinical information. This study aimed to implement telemedicine in pediatric and neonatal tr...