Telemedicine in critical care: collaborative experience in postoperative pediatric cardiac care

María Althabe, Unidad de Cuidados Intensivos 35, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Paula Martínez-Da Bove, Unidad de Cuidados Intensivos 35, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Celeste Arancibia, Terapia Intensiva Pediátrica, Hospital Materno-Infantil de Salta, Salta, Argentina
Mercedes Montonati, Unidad de Cuidados Intensivos 35, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Sandra Chuchuy, Terapia Intensiva Pediátrica, Hospital Materno-Infantil de Salta, Salta, Argentina
Doris Flores, Terapia Intensiva Pediátrica, Hospital Materno-Infantil de Salta, Salta, Argentina
Noelia De Maio, Unidad de Cuidados Intensivos 35, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Mariana Fenoy, Unidad de Cuidados Intensivos 35, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Edgardo Rodríguez, Relaciones Institucionales, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina
Laura Selvatici, Relaciones Institucionales, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina

Objectives: Telehealth applied to the perioperative care of pediatric patients with congenital heart disease facilitates sharing experiences and provides valuable support to institutions initiating cardiac surgery programs, improving the quality of patient care. The primary goal of this study is to describe the implementation and initial results of a collaborative telehealth program between two cardiac centers with different complexity. Method: Three teleconsultations per patient were programed, one preoperative to identify risks and discuss postoperative strategies, the second immediate after admission, and the last on day 2 pop. Demographic data, diagnosis, and surgical procedures (RACHS-1 scale) were recorded. A satisfaction survey was completed at the end of the process for each patient. A descriptive analysis was performed (Stata®). Results: One hundred and twenty-three patients were consulted in 154 connections, with an average of 25 min consultation. Diagnoses included ventricular septal defect, atrial septal defect, and aortic coartation. The proportion of patients undergoing more complex procedures (RACHS-1 ≥ 3) increased from 9.5 to 35%. Survey results indicated that teleconsultation significantly contributed to problem-solving and understanding (100%), suggested new studies (18.6%), or new diagnoses (16.3%), modifications in therapeutic proposals (37.2%), and follow-up protocols (49%). Connectivity issues (41.8%) and challenges in coordinating consultation schedules (42%) were identified as the main difficulties. Conclusions: Throughout the program, the complexity of RACHS-1 ≥ 3 procedures increased from 9.5 to 35%. Teleconsultation demonstrated notable enhancements in understanding and problem-solving capabilities, despite challenges in connectivity and scheduling coordination.

Keywords: Telehealth. Congenital heart disease. Pediatric cardiac intensive care.