184 - Descriptive Characteristics and Outcomes of Pediatric Patients Admitted by an Overnight Telehospitalist Service to Community Hospitals

Publication Number: 184.4256

Annalise Van Meurs, University of Utah School of Medicine, Salt Lake City, UT, United States; Matthew Steinfeldt, University of Utah School of Medicine, Pleasant Grove, UT, United States; Nathan Money, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Pediatric inpatient care has become increasingly regionalized and dependent on large children’s hospitals, causing pediatric patients to travel larger distances for inpatient care, experience lack of family or community support, and incur higher healthcare costs. Advances in telemedicine may enable children to be hospitalized closer to home, though studies evaluating the safety and efficacy of telehospitalist programs for pediatric patients are lacking.

Objective: Describe the characteristics and outcomes of patients admitted by pediatric telehospitalists to the pediatric unit of two community hospitals.

Design/Methods: This is a retrospective study among pediatric patients admitted via telehospitalist at two community hospitals over a three month period. Patient data were collected via data query and validated via manual chart review. Demographic data for patients admitted via telehospitalist were described. Additionally, we explored outcomes including length of stay, discharge disposition, safety events, and reutilization including readmission and emergency department return data. Demographic data and outcomes for children with medical complexity were also explored.

Results: 74 patients were admitted by telehospitalist providers during the study period. Median age was 3.5 years (IQR 1–12.75), with 39% of patients being 0-2 years old, and 14 (19%) patients had complex chronic conditions. The most common diagnosis categories were bronchiolitis/pneumonia/croup (32%), behavioral (16%), and asthma (15%). Median length of stay was 1 day (IQR 1–2). Sixty-five (88%) patients were discharged home and 7 (9%) were discharged to a psychiatric facility. Two (3%) patients were transferred to a higher level of care; a 7-week-old with bronchiolitis to a pediatric intensive care unit for non-invasive ventilatory support, and a 17-year-old with acute respiratory distress syndrome to an adult intensive care unit for intubation and eventual extra-corporal membrane oxygenation. Four (5%) patients returned to the emergency center within 30 days, 2 (3%) of which were readmitted.

Conclusion(s): This is the first study to report demographics and outcomes of pediatric patients admitted via an overnight telehospitalist service to community hospitals. Children admitted via overnight telehospitalist service had low rates of care escalation and reutilization, suggesting this may be a safe option for community hospital nighttime coverage.