MassGeneral Program Brings Remote Doctor to the Bedside 24/7

A "home-to-hospital" program in use at MassGeneral Hospital for Children uses real-time video communication that enables an on-call attending physician, from their home, to personally examine patients and communicate directly with staff, other specialists, and even the patients' relatives.

Through the Connected Pediatric Critical Care program, six Pediatric Intensive Care Unit physicians from MassGeneral currently have the videoconferencing units in their homes. When they are need to consult patients and families while away from the hospital, they can videoconference in from home to a portable telemedicine station at the patient's bedside.

"The physicians, nurses, and therapists at the bedside have felt better with the new system in place due to their ability to directly communicate with the attending physician, see him/her, and continue to do whatever is necessary to treat the patient while this communication is taking place," says Natan Noviski, MD, chief of Pediatric Critical Care Medicine at MassGeneral Hospital for Children. "The attending physicians at home feel that they actually can better help with the decision-making and management of the clinical scenario that triggered the call."

The new system includes a telemedicine station at the homes of each senior attending physician covering the PICU at night, and a mobile cart, nicknamed the PICUBOT, that can be moved from bed to bed as needed.

Using the telemedicine system, the attending physician can then see the patient, talk with clinicians on-site, personally evaluate the child's condition, and make treatment decisions. Special cameras and scopes can also be attached to the telemedicine station to allow for closer evaluation of the patient.

"From home, the attending MD uses a remote to control the camera located in the PICUBOT, which is stationed at the patient's bedside," Noviski said. "The team at the bedside can see the attending MD ins the screen of the PICUBOT."

In the past, during the night and on weekends, on-call attending physicians at MassGeneral Hospital for Children were traditionally contacted via telephone by the covering resident in the PICU. The attending physician would provide guidance, via telephone, without input from the rest of the team and without personally seeing the patient. The attending physician would also have to decide if it was necessary to return to the hospital.

Since the program launched in 2009, the Connected Pediatric Critical Care program has significantly improved the quality of care, team communication, and staff responsiveness during evening hours and weekends when attending physicians have left the hospital to home, Noviski says.

"With the old system … the attending at home did not have the ability to see the patient or have input from the other team members or from the parents, if they were at the bedside," Noviski says. "This system allows for a multidisciplinary communication based on being able to see the critically ill child rather than a 'blind,' two-person only conversation. This improved communication obviously benefits the patients as well."

The Connected Pediatric Critical Care program was launched at MassGeneral for Children in partnership with the Center for Connected Health, a division of Partners HealthCare. Boston-based Partners HealthCare is an integrated health system founded by Brigham and Women's Hospital and Massachusetts General Hospital, and the Center is designed to help providers develop innovative technology that can be implemented in the care setting.

"Videoconferencing is not new, but the application of this technology—connecting at-home physicians with their patients and the hospital-based medical team—is a novel and important advance in critical care medicine," said Joseph C. Kvedar, MD, director of the Center for Connected Health, in a statement.

The program creates a teaching opportunity as well, allowing residents to be more involved in a team approach that benefits the care environment, proponents say. It can also help parents feel more confident in the attending physician because it gives them more of an opportunity to interact with the doctor.

Kvedar and Noviski added that other intensive care units, for both adults and pediatric patients, could benefit from similar home-to-hospital telemedicine systems.

"If successful, this program can be incorporated into all of the ICUs and patient floors," Noviski says.