This study will be a cluster randomized controlled trial to assess the impact of telemedicine in Pediatric Intensive Care Units (PICU), through daily tele-rounds with a board certified physician and educational activities, in improving clinical-assistance indicators, as well as reducing the length of stay in the PICU.
This is a parallel cluster randomized controlled trial in pediatric intensive care units in Brazil. PICUs is the unit of randomization. All patients admitted to the PICUs selected to participate in the project will be included in the study allocated to the control or intervention group as their respective hospitals are randomized. Intervention group: Tele-rounds are case discussions with remote pediatric intensive care physicians and physicians from other specialties, such as a radiologist, infectious disease specialist, for the debate on conducts based on the best scientific evidence. Additionally, concurrently with the period of application of the intervention, continuing education activities will be made available to all professionals from the teams of the participating centers. Education activities are held monthly and consist of video classes and discussions of complex cases. Control group: This group will maintain the usual care offered by the participating centers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
1,760
Tele-Critical Care: 1) establishing a diagnosis 2) guiding the therapeutic approach and 3) performing clinical follow-up. Physicians will discuss all patients in the unit, bed by bed, evaluating the specific clinical situation of each hospitalized patient, according to the protocol developed by the study.The proposal is to maintain horizontal care (the patient is monitored from the 1st day of hospitalization until discharge) for all patients in the unit. \+ Continuing education activities: video classes and discussions of complex cases.
Lenght of stay
Time until discharge from the Pediatric intensive care unit
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
To measure PICU mortality
To measure the mortality rate in PICUs
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
To check the days free from mechanical ventilation
To check the days free from mechanical ventilation of patients hospitalized in PICUs
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
To measure the time of use of vasoactive drugs
To measure the time of use of vasoactive drugs by patients hospitalized in PICUs
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
To measure the time of use of broad-spectrum antibiotics
To measure the time of use of broad-spectrum antibiotics in patients hospitalized in PICUs
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
To measure the time of use of sedation/analgesia
To measure the time of use of sedation/analgesia in patients hospitalized in PICUs
Time frame: From PICU admission until the date of PICU discharge or death, whichever comes first, assessed up to 90 days
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