2700 Crit Care Med 2012 Vol. 40, No. 9 T elemedicine has been employed in adult intensive care units (ICUs) to allow intensivists to care for patients at several ICUs simultaneously. In this model, a teleinten- sivist can sit in an off-site control center surrounded by equipment that enables monitoring of vital signs, electrocardio- gram tracings, imaging, and laboratory val- ues and communicate with bedside staff in real time (1–3). To date, telemedicine has been used in pediatric ICUs (PICUs) pri- marily as an outreach tool to help stabilize and monitor pediatric patients at outly- ing community hospitals in preparation for transport to a PICU (4, 5). In addition, there are reports of pediatric intensivists providing subspecialty consultation to critically ill pediatric patients being man- aged by adult intensivists in ICUs lacking pediatric subspecialty expertise (6, 7). A case report has described resuscitation in a PICU facilitated by interactive sup- port from an on-call pediatric intensivist via telemedicine (8). Furthermore, several studies have shown that physical assess- ments made via telemedicine connections compare favorably to those made directly at the bedside (9–11). We hypothesized that the use of nighttime telemedicine can help staff intensivists remotely manage patients in a PICU, where fellows provide nighttime, on-site care, with supervision by staff intensivists available by pager. MATERIALS AND METHODS Following Institutional Review Board ap- proval by the Massachusetts General Hospital, a retrospective study was conducted in a uni- versity-affiliated, 14-bed, PICU. In our PICU, a pediatric critical care fellow is the most quali- fied on-site provider of care during nights, with supervision by a staff attending intensivist avail- able by pager and who returns to the hospital if direct bedside supervision becomes necessary. Telemedicine Model. Telemedicine is achieved by having a self made mobile tele- medicine cart (“PICUbot”) available in the PICU and a home-based unit for each staff at- tending intensivist. The connection between the “PICUbot” and the home units uses Health Insurance Portability and Accountability Act- compliant Internet connectivity, including mechanisms to authenticate, encrypt, and decrypt electronic protected health informa- tion. Bedside staff accepts incoming video calls only after they have paged/instructed the staff intensivist to dial in for live conferencing. At all other times, the PICUbot is in a storage area where no electronic protected health in- formation resides. An AES-128 bit encryption secures the audio/video connection, end to end, through secure firewall traversal between the hospital’s business network and each staff intensivist’s home network. Consultations are not recorded, thereby obviating the need for stored electronic protected health information protection from improper alteration or destruc- tion. Connections are made through the H.323 videoconferencing infrastructure at speeds Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e3182591dab Objective: To investigate the hypothesis that nighttime tele- medicine can help staff intensivists remotely manage patients in a pediatric intensive care unit, preserve continuity of care, commu- nicate with the bedside team, and provide reassurance to families in a unit where fellows provide nighttime, onsite care, with super- vision by staff intensivists available by pager. Design: A retrospective review. Setting: A pediatric intensive care unit in an academic, tertiary medical center with telemedicine capability, including a mobile telemedicine cart in the pediatric intensive care unit and a home- based unit for each pediatric staff intensivist. Patients: Critically ill pediatric patients between 0 and 19 yrs, who were admitted to the pediatric intensive care unit between May 2010 and July 2011 and were managed via telemedicine. Interventions: Consecutive intake forms completed by staff intensivists following each telemedicine encounter were reviewed. Main Results: Fifty-six consecutive intake forms were evalu- ated for the study period. Connectivity was established in 95% of attempts. Audio and video qualities were excellent 94% and 85% of the time, respectively. The median call duration was 15 mins. The pediatric critical care fellow was present for 100% of calls, nurses 68%, and parents 66%. Reasons for initiating the call were “patient assessment” (98%), “team meeting” (25%), and/ or parent update (40%). “Patient assessment,” “communication with multidisciplinary care team,” and “communication with a patient’s family” were the outcomes most often cited that would not have been possible via telephone. A change in medical man- agement was noted following 32% of encounters. Conclusions: This study demonstrates that nighttime telecom- munication linking staff intensivists on home-call with pediatric intensive care unit bedside care providers, patients, and their families is technologically feasible and may enhance team com- munication, provide reassurance to families, and impact patient management. (Crit Care Med 2012; 40:2700–2703) KEY WORDS: communication; critical care; pediatrics; pediatric intensive care unit; staffing models; telemedicine Nighttime telecommunication between remote staff intensivists and bedside personnel in a pediatric intensive care unit: A retrospective study* Phoebe H. Yager, MD; Brian M. Cummings, MD; Michael J. Whalen, MD; Natan Noviski, MD, FAAP, FCCM s *See also p. 2731. From the Pediatric Critical Care Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA. Departmental funding is provided by the Department of Pediatrics, Massachusetts General Hospital. Listen to the Critical Care podcasts for an in-depth interview on this article. Visit www.sccm. org/iCriticalCare or search “SCCM” at iTunes. The authors have not disclosed any potential con- flicts of interest. For information regarding this article, E-mail: nnoviski@partners.org