Triage through telemedicine in paediatric emergency care-Results of a concordance study
In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. I...
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| Veröffentlicht in: | PloS one 2022-05, Vol.17 (5), p.e0269058-e0269058 |
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| creator | Beyer, Angelika Moon, Kilson Penndorf, Peter Hirsch, Thomas Zahn-Tesch, Uta Hoffmann, Wolfgang Lode, Holger N van den Berg, Neeltje |
| description | In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system.
Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen's kappa, between the two paediatricians. We have also included patient and assessor demographics.
A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician's and telemedicine paediatrician's urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient's condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen's weighted kappa was 0.64 (95% CI: 0.49-0.79), indicating a substantial agreement between the specialists.
Telemedical triage |
| doi_str_mv | 10.1371/journal.pone.0269058 |
| format | Article |
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Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen's kappa, between the two paediatricians. We have also included patient and assessor demographics.
A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician's and telemedicine paediatrician's urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient's condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen's weighted kappa was 0.64 (95% CI: 0.49-0.79), indicating a substantial agreement between the specialists.
Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals' organisational processes. The processes should include intensive training for the doctors involved in telemedical triage.
DRKS00013207.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0269058</identifier><identifier>PMID: 35617339</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acuity ; Children ; Conferencing systems ; Data collection ; Demographics ; Documentation ; Emergency medical care ; Emergency medical services ; Evaluation ; Health care ; Health services ; Hospitals ; Medical care ; Medical diagnosis ; Medicine and Health Sciences ; Onsite ; Pain ; Parents ; Patients ; Pediatric emergencies ; Pediatrics ; People and Places ; Physicians ; Quality management ; Rural areas ; Sociodemographics ; Teenagers ; Telemedicine ; Video teleconferencing ; Videoconferencing ; Virtual private networks</subject><ispartof>PloS one, 2022-05, Vol.17 (5), p.e0269058-e0269058</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Beyer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Beyer et al 2022 Beyer et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-975a09e81940f0741353e7302f16800f124857fdd3337f1c2a47aa72473103b03</citedby><cites>FETCH-LOGICAL-c692t-975a09e81940f0741353e7302f16800f124857fdd3337f1c2a47aa72473103b03</cites><orcidid>0000-0002-2314-9057 ; 0000-0003-4654-4233</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135216/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135216/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35617339$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Chen, Tai-Heng</contributor><creatorcontrib>Beyer, Angelika</creatorcontrib><creatorcontrib>Moon, Kilson</creatorcontrib><creatorcontrib>Penndorf, Peter</creatorcontrib><creatorcontrib>Hirsch, Thomas</creatorcontrib><creatorcontrib>Zahn-Tesch, Uta</creatorcontrib><creatorcontrib>Hoffmann, Wolfgang</creatorcontrib><creatorcontrib>Lode, Holger N</creatorcontrib><creatorcontrib>van den Berg, Neeltje</creatorcontrib><title>Triage through telemedicine in paediatric emergency care-Results of a concordance study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system.
Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen's kappa, between the two paediatricians. We have also included patient and assessor demographics.
A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician's and telemedicine paediatrician's urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient's condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen's weighted kappa was 0.64 (95% CI: 0.49-0.79), indicating a substantial agreement between the specialists.
Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals' organisational processes. The processes should include intensive training for the doctors involved in telemedical triage.
DRKS00013207.</description><subject>Acuity</subject><subject>Children</subject><subject>Conferencing systems</subject><subject>Data collection</subject><subject>Demographics</subject><subject>Documentation</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Evaluation</subject><subject>Health care</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Medical care</subject><subject>Medical diagnosis</subject><subject>Medicine and Health Sciences</subject><subject>Onsite</subject><subject>Pain</subject><subject>Parents</subject><subject>Patients</subject><subject>Pediatric emergencies</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Quality management</subject><subject>Rural areas</subject><subject>Sociodemographics</subject><subject>Teenagers</subject><subject>Telemedicine</subject><subject>Video 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Sciences</topic><topic>Onsite</topic><topic>Pain</topic><topic>Parents</topic><topic>Patients</topic><topic>Pediatric emergencies</topic><topic>Pediatrics</topic><topic>People and Places</topic><topic>Physicians</topic><topic>Quality management</topic><topic>Rural areas</topic><topic>Sociodemographics</topic><topic>Teenagers</topic><topic>Telemedicine</topic><topic>Video teleconferencing</topic><topic>Videoconferencing</topic><topic>Virtual private networks</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beyer, Angelika</creatorcontrib><creatorcontrib>Moon, Kilson</creatorcontrib><creatorcontrib>Penndorf, Peter</creatorcontrib><creatorcontrib>Hirsch, Thomas</creatorcontrib><creatorcontrib>Zahn-Tesch, Uta</creatorcontrib><creatorcontrib>Hoffmann, Wolfgang</creatorcontrib><creatorcontrib>Lode, Holger N</creatorcontrib><creatorcontrib>van den Berg, 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one</jtitle><addtitle>PLoS One</addtitle><date>2022-05-26</date><risdate>2022</risdate><volume>17</volume><issue>5</issue><spage>e0269058</spage><epage>e0269058</epage><pages>e0269058-e0269058</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system.
Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen's kappa, between the two paediatricians. We have also included patient and assessor demographics.
A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician's and telemedicine paediatrician's urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient's condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen's weighted kappa was 0.64 (95% CI: 0.49-0.79), indicating a substantial agreement between the specialists.
Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals' organisational processes. The processes should include intensive training for the doctors involved in telemedical triage.
DRKS00013207.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35617339</pmid><doi>10.1371/journal.pone.0269058</doi><tpages>e0269058</tpages><orcidid>https://orcid.org/0000-0002-2314-9057</orcidid><orcidid>https://orcid.org/0000-0003-4654-4233</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-05, Vol.17 (5), p.e0269058-e0269058 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2686265890 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acuity Children Conferencing systems Data collection Demographics Documentation Emergency medical care Emergency medical services Evaluation Health care Health services Hospitals Medical care Medical diagnosis Medicine and Health Sciences Onsite Pain Parents Patients Pediatric emergencies Pediatrics People and Places Physicians Quality management Rural areas Sociodemographics Teenagers Telemedicine Video teleconferencing Videoconferencing Virtual private networks |
| title | Triage through telemedicine in paediatric emergency care-Results of a concordance study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T08%3A43%3A08IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Triage%20through%20telemedicine%20in%20paediatric%20emergency%20care-Results%20of%20a%20concordance%20study&rft.jtitle=PloS%20one&rft.au=Beyer,%20Angelika&rft.date=2022-05-26&rft.volume=17&rft.issue=5&rft.spage=e0269058&rft.epage=e0269058&rft.pages=e0269058-e0269058&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0269058&rft_dat=%3Cgale_plos_%3EA705025477%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2686265890&rft_id=info:pmid/35617339&rft_galeid=A705025477&rft_doaj_id=oai_doaj_org_article_18a3578b5d1647debb51402bff50b7aa&rfr_iscdi=true |