Abstract
BACKGROUND: Mutual support of paediatric hospital departments through a telemedical network can support paediatric care particularly in rural areas with structural deficits. Using a participatory approach, a Regional Tele-Paediatric Network (RTP-Net) was developed and implemented in the northeast of Germany. The tele-paediatric network provides the following functionalities: 1) telemedical triage, 2) subspecialist (video) consultation, 3) virtual background services (24/7) and 4) video consultation with patients at home and was available both for patients of the emergency room and for inpatients. The aim of the present analysis was to identify which functionalities of the tele-paediatric network were most frequently used and in which diagnostic and treatment contexts they were applied. Additionally, the study examined the impact of telemedicine consultations for paediatric patients on their subsequent treatment. METHODS: Patients under 18 years of age who received telemedical treatment in a participating hospital during the observation period from February 2021 to March 2024 were included in the analysis. The telemedical contact was documented by both, the clinic on site and the telemedicine contact clinic, in a digital patient file on a shared documentation platform (eHealth platform). The documentation included patient data and documents and the diagnostic and treatment recommendations resulting from each telemedical contact quantitative data on utilization, reasons for the telemedicine consultation, and treatment consequences of the telemedical contact were collected using electronic case report forms and were then analysed descriptively. RESULTS: In the study period, 146 physicians from 13 hospitals participated in the development and implementation of RTP-Net (ranging from small hospitals for basic care to university hospitals). N = 403 paediatric patients (thereof 198 female patients) with a total of 507 cases were included, resulting in 519 telemedical contacts. Telemedicine was particularly used for children under 3 years of age (n = 150/403; 37.2%). The most frequently used functionality was the subspecialist consultation (n = 290/519; 55.9%), followed by virtual background duty services (n = 169/519; 32.6%), which were often used as a supplement to the internal on-call duty service. The most common reason for tele-paediatric care were consultations to evaluate symptoms and findings in children with diseases of the nervous system (ICD-10-GM: G00-G99) (n = 161/507; 31.8%), e.g. the joint evaluation of Electroencephalographies (EEGs). In 51/519 cases (9.8%), a hospital admission at the local clinic followed the telemedicine consultation, and in 27/519 cases (5.2%), the patient was transferred to the telemedicine contact clinic. The most frequent outcome was a change in the ongoing treatment (n = 198/519; 38.2%). Hospital admission (n = 51/519) was more common for younger children (median age 6 years) with respiratory system diseases (n = 13), whereas for older children (median age 8 years) with nervous system diseases (n = 124) the telemedicine physician mostly recommended therapy adjustments and these patients usually remained at the clinic on site (n = 198). CONCLUSION: The Regional Tele-Paediatric Network is suitable to support regional paediatric healthcare. Neuropaediatric cases are frequent but often have nonspecific symptoms, which would otherwise require transfer to a more specialized clinic. In the network most paediatric patients could be treated at the clinic on site (local clinic) without needing to seek care at a distant hospital. This avoids long travel distances for the patients and provides economic benefits to the clinic on site, which can continue the treatment of the child locally. TRIAL REGISTRATION: This study was registered under the title ‘Implementation und Evaluation of a Regional Tele-Paediatric Network in Mecklenburg-Western Pomerania and Brandenburg’ (registration no. DRKS00024002, https://drks.de/search/de/trial/DRKS00024002) at the German Registry for Clinical Trials (date of registration 07.01.2021).