On Call: Telemedicine Put To Work In The Emergency Room

It's not just chronically ill patients who benefit from telemedicine. The technology also helps save the lives of children who find themselves in the emergency room.

Childrens Hospital Los Angeles provides remote triage services to five Los Angeles hospitals that don't have pediatric intensive-care units. Instead, these hospitals are equipped with special endoscopy equipment for examining the inside of the body, vital-sign-monitoring equipment, and Web-based video cameras. Via T1 lines, the hospitals transmit clinical patient data from their emergency rooms miles away to a videoconferencing workstation in a room adjacent to Childrens Hospital Los Angeles' intensive-care unit.

This real-time video interaction "is better than being there in the examining room," says Dr. Randall Wetzel, director of critical-care medicine at Childrens Hospital Los Angeles. That's because telemedicine technologies can improve what doctors see on their monitors, versus viewing a patient in person without the aid of equipment such as endoscopy devices, Wetzel says.

The telemedicine services help Los Angeles-area hospitals determine which patients need to be transported and admitted to Childrens Hospital's intensive-care unit, which could require an emergency flight or a long ambulance ride.

In the past, local hospitals would sometimes fly a child who they determined to be seriously sick to Childrens Hospital's ICU for admittance, only to have the child voluntarily walk off the helicopter. In these cases, the child typically didn't require an ICU bed, which often are in short supply, Wetzel says.

On the flip side, Wetzel says, there have been times when ICU doctors on call have helped convince ER doctors or emergency-response workers at local hospitals how seriously ill a child actually was. One such case, he recalls, involved a child who had a serious undiagnosed problem that required a heart transplant.

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