Area hospitals set up telemedicine link with MUSC for pediatric critical care

Jacklyn Viazinica had a feeling that something was wrong with her newborn son. She had taken him to the pediatrician the day before and was told he had a cold.

But things kept nagging at her and when he became lethargic that evening, she and her husband rushed their first baby to the emergency department at Conway Medical Center. Almost as soon as they arrived, he suddenly stopped breathing, was revived by a doctor’s mouth-to-mouth resuscitation, stabilized and flown to the Medical University of South Carolina in Charleston.

There she and her husband checked into a hotel and spent as much time as they could at their son’s bedside in the hospital’s pediatric intensive care unit. Her husband had to return to Horry County after a week, but she stayed another week until her son was ready to go home.

The story might play out the same if it happened again, but in about two weeks, Conway Medical Center will have a telemedicine connection to MUSC that will lead to an estimated 20 percent reduction in the pediatric emergency patients transported elsewhere for care.

Had that been the case for her son, Viazinica said it would have saved her and her husband from the additional financial and emotional tolls of watching their critically-ill child be treated two hours from home.

“They definitely added to the stress,” she said.

Conway will be the first of four Lowcountry hospitals to set up the link with MUSC. Georgetown Memorial and Waccamaw Community hospitals also will be part of the program. With it, local physicians will have immediate access to MUSC’s staff of six pediatric critical care specialists and 12 pediatric emergency medicine specialists.

A mobile cart that is the Conway end of the hookup will let MUSC physicians see the patient either with a camera mounted atop the cart or a handheld camera that can project detailed, close-up pictures of wounds or enflamed throats, for instance. A stethoscope that comes with the cart is connected to another in Charleston through which the MUSC specialist can hear exactly what the physician in Conway hears as he moves it to spots on the young patients.

The cart also transmits things such as x-rays, ultrasound pictures, echocardiogram readings and other diagnostic information in real time.

Quick link to specialist a key

Dr. Charles Tarbert, medical director of Conway’s emergency department, said studies have shown that seeing a specialist quickly will improve a patient’s outcome.

And when that patient is a child, said Brooke Yeager, program coordinator for emergency and inpatient telemedicine at MUSC, the speed can be even more important.

“Children get ill very rapidly compared to adults,” she said.

Dr. David McSwain, assistant professor of pediatric critical care at MUSC, put together the pediatric telemedicine system, taking time to match the equipment with what physicians on both ends would need and feel most comfortable using.

The equipment for the four-hospital start-up can be adapted for use in physicians’ offices, for instance, but also used to diagnose and treat adult patients as well.

“This allows us to be in the room with the patient at the time they need the most care,” McSwain said.

He said it’s very difficult to get an accurate picture of what’s going on with children through a telephone call, which has been the hospital-to- pediatric specialist link up to this point.

The telemedical hook-up was made possible through a $525,000 grant from the Duke Endowment that paid for the four carts and three years’ worth of operation and maintenance. After that, each hospital will assume the ongoing costs that Dr. Preston Strosnider, Conway’s vice president of medical affairs, said is a no-brainer.

The initial four hospitals were chosen because of their high incidence of pediatric critical care patients, Yeager said. Two of the others, Georgetown Memorial and Waccamaw Community, are also on the Grand Strand. Conway spokeswoman Julie Rajotte said she thinks the carts have been delivered there and to Colleton Medical Center, but have yet to be used live.

No one could be reached at the Georgetown hospital system Wednesday afternoon for comment.

McSwain said he doesn’t know for sure why the area has so many pediatric critical care cases, but he believes that it could be related to the millions of tourists who visit the area each year. A number of the patients sent to MUSC from area hospitals are from outside the region, he said.

Grand Strand Regional Medical Center used to have a telemedical connection with MUSC for stroke patients, but spokeswoman Joan Carroza said that no longer exists as the hospital has hired a vascular neurologist. She said Grand Strand is developing its own telemedical system that will allow the neurologist to connect to the system through his iPad.

MUSC physicians can connect to its system remotely, also, and Yeager said in one case a physician was able to assess a patient from an iPad in his car.

Carroza said Grand Strand sends pediatric critical care patients who need specialist care to either MUSC or McLeod Health Hospital in Florence.

10,000 cases a year

Strosnider said that Conway’s emergency department gets about 10,000 pediatric cases (age 18 and under) a year. Of those, 20 are admitted each month and about half of them will be transported to MUSC.

“What happens is they will be admitted and they will get better or they will get worse and we will need a consult,” he said.

Besides the advantages to the families, Strosnider and McSwain said the telemedicine connection can help overcome another challenge of dealing with young children.

“They can’t tell you as much (as adult patients),” he said.

With the carts, the specialists can examine youngsters almost as though they were in the same room.

Tarbert said that while the emergency department uses all its expertise for all patients, children pull at special heart strings.

“Whenever a critically ill child comes in,” he said, “there is a different feel among physicians and staff.”

Viazinica said a nurse was doing an initial assessment on her three-week old son Lukas when he stopped breathing. She remembers the nurse grabbing her child and running down the hall yelling for a doctor.

Viazinica both watched and hid her eyes as a doctor gave Lukas mouth-to-mouth resuscitation. Then she heard him start crying.

“He got really red and I knew that was good,” she said.

Lukas was born six-weeks premature, and Viazinica said she was told that premature babies can contract a respiratory virus, which had happened to her son.

“Luckily, now, he is 2 years old and he’s healthy,” she said.