Telemedicine Protocol
Telemedicine consultations involved synchronous audio-video communication and were initiated after the referring ED physician and the UCDCH pediatric critical care physician were connected for a brief telephone conversation via the transfer center. The telemedicine consultation involved the referring physician, bedside nurse, respiratory therapist, patient, and patient’s parents/guardians, when available, and always involved a visual assessment and physical examination of the patient. Telemedicine units in the referring EDs consisted of a pole-mounted, high-resolution videoconferencing unit with pan-tilt-zoom capabilities that use the internet for high-definition video (minimum 1 megabits per second, 720 pixels). During the study period, remote access to the participating ED medical records was not available. Therefore, all components of the medical history, including laboratory test results, were obtained via communication with the referring physician. Telemedicine capabilities at the UCDCH were accessible via workstation computers using videoconferencing software, a headset, and a webcam.