Qualification of Pediatric Intensive Care Assistance through Telemedicine

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1. Information regarding the person in charge of the pediatric ICU Name:

Telephone (work): Mobile phone:

Fax: E-mail:

2. Information regarding the pediatric ICU Name of the institution:

Number of beds:

Type of insurance:

( ) Public health care (Unified Public Health System) ( ) Private health care insurance

Type of pediatric ICU:

( ) Medical ( ) Surgical ( ) Mixed Clinical-Surgical ( ) Neuro-ICU ( ) Trauma ( ) Another specialty. Which? __________________.

Quality certification ( ) No ( ) Yes, Which one?________________________.

Management (please answer “public health” when the main payment source is the Unified Public Health System):

( ) Public health ( ) Private philanthropy ( ) Private without philanthropy

3. Information regarding the pediatric ICU – Medical area Number of routine physicians:

Number of physicians on duty:

Number of pediatric intensive care doctors:

Medical team working scale:

Morning ( ) On duty ( ) Routine Numbers of physicians:

Afternoon ( ) On duty ( ) Routine Numbers of physicians:

Night ( ) On duty ( ) Routine Numbers of physicians:

Weekends ( ) On duty ( ) Routine Numbers of physicians:

Comments:

Invasive and non-invasive monitoring devices ( ) No ( ) Yes ( ) All beds Comments:

Number of ventilators:

Types of ventilators:

Does the ICU have surgical support? ( ) No ( ) Yes Comments:

Does the hospital have its own clinical laboratory? ( ) No ( ) Yes

Does the hospital have difficulties performing any laboratory exams? ( ) No ( ) Yes.

Which ones?

Radiology exams and procedures:

( ) Computed Tomography (CT) ( ) X-ray ( ) Ultrasound ( ) Bedside ultrasound ( ) Doppler ultrasound ( ) Eletrocardiogram ( ) Electroencephalogram

Qualification of Pediatric Intensive Care Assistance through Telemedicine

Technical evaluation of the pediatric ICU

2 Are there clinical protocols and guidelines? ( ) No ( ) Yes

Which ones?

PIM2 (Pediatric Index of Mortality 2) in patient medical charts ( ) No ( ) Yes ( ) No, but it is calculated

Are there medical specialties?

( ) Pneumologist ( ) Cardiologist ( ) Neurologist ( ) Others:

4. Information regarding the pediatric ICU – Nursing area Number of nurses:

Number of physiotherapists working in the pediatric ICU:

Number of pharmacists working in the pediatric ICU:

Number of nutritionists working in the pediatric ICU:

Number of psychologists working in the pediatric ICU:

Number of nursing technicians:

Are there meetings for staff debriefing and discussions?

( ) No ( ) Yes. Frequency:

Nursing team working time scale:

Morning Numbers of nurses: Numbers of nursing technicians:

Afternoon Numbers of nurses: Numbers of nursing technicians:

Night Numbers of nurses: Numbers of nursing technicians:

Weekends Numbers of nurses: Numbers of nursing technicians:

Comments:

Are there healthcare protocols? ( ) No ( ) Yes Which ones?

Is there a system for registering medical occurrences such as falls, phlebitis and medication errors?

( ) No ( ) Yes If yes, specify: ( ) Manual ( ) System ( ) Others:

5. Information regarding the available technology Wifi ( ) No ( ) Yes

Internet link ( ) No ( ) Yes If yes, internet speed:

Internet dedicated link ( ) No ( ) Yes If yes, internet speed:

Firewall ( ) No ( ) Yes Network points ( ) No ( ) Yes Structured network ( ) No ( ) Yes

Radiology Information System ( ) No ( ) Yes

Electronic medical records ( ) No ( ) Yes Which one:

Picture Archiving and Communication System ( ) No ( ) Yes Which one:

Billing System ( ) No ( ) Yes

3 6. Management information – Healthcare indicators

Medical database ( ) No ( ) Yes

Healthcare indicators ( ) No ( ) Yes Frequency:_____________

Average length of stay ( ) No ( ) Yes

Mortality rate ( ) No ( ) Yes

Central line-associated bloodstream infection ( ) No ( ) Yes Catheter-associated urinary tract infection ( ) No ( ) Yes

Fall / Fall-related injury ( ) No ( ) Yes

Occupancy rate ( ) No ( ) Yes

Incidence/prevalence of pressure ulcers ( ) No ( ) Yes

Ventilator-associated pneumonia ( ) No ( ) Yes

Duration of mechanical ventilation/non-invasive ventilation ( ) No ( ) Yes

Duration of vasoactive drug use ( ) No ( ) Yes

Readmission rate PIM-2 or other?

( ) No ( ) Yes

Others:

Monitoring of antibiotic consumption (stock, administration) by the Hospital Infection Control Committee ( ) No ( ) Yes

Measurement of absenteeism among healthcare professionals ( ) No ( ) Yes Daily cost of absence/leave ( ) No ( ) Yes

Number of overtime hours paid ( ) No ( ) Yes

7. Information regarding research and teaching

Is there an Institutional Review Board ( ) No ( ) Yes

Is there any teaching activity in the hospital? ( ) No ( ) Yes Which ones?

( )

Healthcare professionals who have already taken distance education courses:

Physicians ( ) All ( ) None ( ) Some

Nurses ( ) All ( ) None ( ) Some

Nursing technicians ( ) All ( ) None ( ) Some