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When Distance Is a Hurdle

When Distance Is a Hurdle

Patients with chronic conditions who live in rural areas, infants awaiting preoperative assessments and children in intensive care settings — these were the concerns of Johns Hopkins Children’s Center clinicians in their development of recent telemedicine initiatives.

“This is where the future of health care is headed,” says pediatrician Helen Hughes. “Video technologies can allow us to do so many things for our patients without having to see them in person every time.”

Hughes is referring to the Children’s Center’s telemedicine program on Maryland’s Eastern Shore, where families of patients with chronic conditions have had to frequently travel long distances to see their child’s pediatric subspecialists in Baltimore.

“There were weeks when Colin and I would cross the Chesapeake Bay Bridge five times for five different appointments,” recalls parent Christy Russell. Now Russell’s and other families take a much shorter trip to the nearby Talbot County Health Department, the Children’s Center’s partner in the initiative, to follow up with pediatric subspecialists such as nephrologist Alicia Neu, endocrinologist Risa Wolf and pulmonologist Laura Sterni.

In another initiative, Johns Hopkins pediatric intensivists are assessing infants awaiting surgery. However, they are conducting the preoperative evaluations at Mt. Washington Pediatric Hospital in Northwest Baltimore via video — not in person at the Children’s Center — as these are medically fragile babies, some of whom are on ventilation support. The initiative benefits families, too.

“Transporting a medically fragile infant is expensive and not without risks, and the chances are the family could not be there (at the Children’s Center) at the same time because they’ve used up all of their available time away from work and other children,” says pediatric anesthesiologist Sally Bitzer. “This is a way in which they can also be part of the visit.”

Although the two-year program is in its infancy, results include fewer surgery cancellations due to patients showing up for their anesthesiology assessment the morning of their surgery.

In yet another telemedicine project, nurses new to the intensive care unit (ICU) benefit from another experienced set of eyes and ears when managing complex patients. The eyes and ears belong to veteran ICU nurses remotely stationed in a room lined with monitors that virtually connect them with new nurses in the 44-bed ICU. These base nurses act as knowledgeable backup resources to improve safety.

“If I have to check medications or run to the pharmacy, I can call the base nurse and ask her to keep an eye on my patient, which gives me peace of mind,” says ICU nurse Priya Toussaint.

Under the tele-ICU model, the unit has had improved patient adherence to high-risk medications and fewer central line-associated bloodstream infections (CLABSI). 

--Gary Logan 

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