November 21, 2018
At Johns Hopkins Children’s Center, anesthesiologists Ivor Berkowitz, Joann Hunsberger and Sally Bitzer conduct a preoperative anesthesia evaluation of a young patient, with his mother and Richard Katz, chief medical officer at Mt. Washington Pediatric Hospital.
Medically fragile infants on ventilation support at community or rural hospitals without surgical services sometimes need those services. That poses a challenge for pediatric anesthesiologists who need to assess these babies preoperatively and discuss their anesthesia plan for surgery with their parents without transporting such vulnerable patients. For Joann Hunsberger and Sally Bitzer, anesthesiologists and critical care specialists at Johns Hopkins Children’s Center, the answer is a collaborative telemedicine program with Mt. Washington Pediatric Hospital in Baltimore.
“Telemedicine is a way to reach that patient population before they come for surgery without having to transport these medically complicated babies on ventilators or oxygen,” says Hunsberger.
“Transporting a medically fragile infant is expensive and not without risks, and the chances are the family could not be there at the same time because they’ve used up all of their available time away from work and other children,” adds Bitzer. “This is a way in which they can also be part of the visit.”
Richard Katz, chief medical officer and vice president of medical affairs at Mt. Washington Pediatric Hospital, agrees.
“The ability to have Johns Hopkins pediatric anesthesiologists review a patient's history, examine the patient, listen to the patient’s heart and lungs and discuss the upcoming surgery without the patient ever leaving the bed is revolutionary,” says Katz. “This process is also very cost efficient as it dramatically reduces nursing and ambulance transport costs.”
Mimicking the preoperative anesthesia assessment in their brick and mortar clinic, the two anesthesiologists’ telemedicine consultation typically includes the patient’s history, allergies and current medications, previous surgical interventions, type of anesthesia received and any related complications, and difficulty with ventilation. In the physical exam, says Hunsberger, “The most important part is the airway evaluation.”
Bitzer and Hunsberger, noting that there is little in the literature regarding anesthesia telemedicine, hope their initiative will help advance the science. Although the two-year program is in its infancy and consults with only a few patient families each week, results include fewer surgery cancellations due to patients showing up for their anesthesiology assessment the morning of their surgery.
“In those cases, we may not have been fully informed of their condition,” says Bitzer.
How have the parents responded?
“Parents have been really open to it; they have made themselves available, and they’ve come with great questions,” says Hunsberger. “We feel like we’ve been able to answer their questions, and we’ve had the time to do it.”
An added value, says Bitzer, has been an enhanced relationship with the Mt. Washington providers: “We now know them face to face because of our conversations through telemedicine.”