Virtual Robotic Doctor’ Working with Intensive Care Staff at Childrens Hospital Los Angeles

Contact: Steve Rutledge at (323) 361-4121

LOS ANGELES – If your child is a patient in two of the three intensive care units at Childrens Hospital Los Angeles and mentions that a robot dropped by to examine him, he is not necessarily imagining things.

For more than a year, the In-Touch Health RP-7™ robot – a sort of telemedicine system on wheels, enabling doctors who are away from the hospital to instantly interact with patients, their families and staff via laptop computers – has become as familiar a part of the intensive care landscape at Childrens Hospital Los Angeles as the IV poles and cardiac monitors.

The duties of this RP-7™ robot are being overseen by the telemedicine team in both the Pediatric Intensive Care Unit (PICU) and the Cardiothoracic Intensive Care Unit (CTICU) at Childrens Hospital Los Angeles that helped pioneer the Laura P. and Leland K. Whittier Virtual PICU (VPICU). Childrens Hospital is the nation’s first pediatric hospital to remotely manage the PICU with the aid of a wireless, mobile “Remote Presence.”

Ashraf Abou-Zamzam, M.D., medical director of telemedicine for the Whittier VPICU at Childrens Hospital Los Angeles, makes it clear that he regards the device more as a medical tool than as a colleague.

“We are not looking to replace doctors with robots,” he says. “We’re trying to enhance the delivery of care because there just are not enough intensive care physicians to provide it.” In the U.S., an estimated 1,000 pediatric intensivists cover more than 400 PICUs, according to Randall Wetzel, MB, BS, FCCM, FAAP, chief of the Department of Anesthesiology Critical Care Medicine, director of the Laura P. and Leland K. Whittier Virtual PICU at Childrens Hospital Los Angeles and professor of pediatrics and anesthesiology at the Keck School of Medicine of the University of Southern California.

Dr. Abou-Zamzam views the remote presence robotic technology as a milestone in medicine that will transform health care and improve the outcomes of countless children.

“What we’re talking about is a paradigm shift in how sick kids are cared for in their community,” he says. “Right now, it’s a centralized model in which children are transported to the nearest pediatric facilities with a PICU. That’s an incredible stress on the health care system.”

It’s also stressful for the family, says Dr. Abou-Zamzam. Presuming a bed can be found in a pediatric intensive care unit, transporting a child away from his community can place enormous emotional and financial burdens on the patient’s family.

“Here’s the most stressful time in their lives, when a child is as a sick as can be, we uproot them from where they live and their local support systems,” he says. Families must either make the daily commute to the hospital or take up residence nearby.

During the past few years, Childrens Hospital has utilized telemedicine in five Southland hospitals so far and significantly advanced patient care, research and education nationwide thanks to a multi-year grant funded by the L.K. Whittier Foundation. Earlier technology (a television and camera mounted on a cart) was state-of-the-art at the time, and provided lifesaving care on numerous occasions. With the advent of broadband Internet, along with a more streamlined, patient-friendly robotic model, and continual refinements in technology, more robots seem destined to be reporting for work in intensive care units and emergency rooms.

Now, medical consultation can be instantaneous, explains Dr. Abou-Zamzam. In the time it takes to return a page, the physician can rely on this remote presence, using his laptop computer and an Internet connection to activate the robot in the unit, and “drive” it over to the child’s bedside for a first-hand look.

“We can beam right in and be virtually there within minutes,” he explains. Peering into his laptop screen to study the child, the doctor can assess the patient’s condition (thanks to equipment like a digital stethoscope), analyze physiologic data in real time, and even preside over a Code Blue trauma alert.

“Having instant access with this robot gives us enough information to perform accurate assessments, diagnoses and start treatment remotely – ideally during the first ‘golden hour’ after a patient is brought to the hospital. The technology is getting that good.”

Pediatric intensivist Sylvia del Castillo, M.D., has witnessed the value of the robot. One of her patients, a three-day old baby with hypoplastic left heart syndrome, underwent the first stage of cardiac surgery earlier that day to provide adequate blood flow to both the lungs and the body. When Dr. Del Castillo left that night, the baby was doing well. However, at 2:30 a.m. the following morning, Dr. Del Castillo received a call from the unit that the baby was coding and her colleagues had begun chest compressions.

“Hang up and unplug the robot from the wall,” she calmly instructed.

Within two minutes, she had piloted the robot over to the child’s bedside, and through its camera could assess the baby for herself.

During the next two hours, she oversaw the code, and ordered tests to monitor the baby’s progress. She was able to closely monitor the vital signs on the patient as one of the surgical fellows came in, opened the child’s chest, and placed her on the extra corporeal membrane oxygenation (ECMO) circuit. “It was very reassuring to have the technology at your fingertips in a critical situation when time is of the essence,” she said. “You don’t have to worry about speeding down the highway at 2 a.m. not knowing what is happening during those critical minutes.”

Incorporating the robot into the routine practice within the PICU and the CTICU at Childrens Hospital Los Angeles ensures that the robotic technology can be safely used in other hospitals that do not have pediatric intensive care units.

“The idea is to be able to provide pediatric expertise to adult facilities so we can work in collaboration with adult intensivists, enabling them to keep the kids in the hospitals in their own communities, and allowing them to receive the care they need there,” she says.

In this era of cost containment, “It’s very rare for a hospital to have a pediatric intensive care unit,” explains Dr. Abou-Zamzam. “The trend is not to expand pediatric ICUs, especially where they’re only seeing a handful of children a month. So, this gives facilities that only see a few children a low-cost alternative to keep them there.”

At Childrens Hospital Los Angeles, the robot now shuttles between the PICU and the CTICU down the hall. Reactions generally have been favorable, although patients sometimes are initially wary. Dr. Abou-Zamzam recalls remotely wheeling the robot down the hallway between the PICU and CTICU one day when he encountered a little girl with her mother.

Seeing Dr. Abou-Zamzam’s face on the television monitor attached to the device rolling down the hall, she darted behind her mother’s legs. Once he introduced himself, she came out for a closer inspection. Before long, she was as mesmerized as if she were face to face with her favorite cartoon character. “Within a few minutes,” he says, “she went from hiding behind her mom to hugging me.”

A fitting metaphor, perhaps, for those who shrink from, then embrace, new technology.

Supporting this innovative transformation in patient care is the L.K. Whittier Foundation. Since 1955, the L. K. Whittier Foundation has founded or made major charitable contributions to a wide range of not-for-profit endeavors in Southern California and throughout the U.S. Areas of involvement include health, education, scientific research, museum programs, the performing arts and youth development.

Founded in 1901, Childrens Hospital Los Angeles has been treating the most seriously ill and injured children in Los Angeles for more than a century, and it is acknowledged throughout the United States and around the world for its leadership in pediatric and adolescent health. Childrens Hospital is one of America’s premier teaching hospitals, affiliated with the Keck School of Medicine of the University of Southern California since 1932. It is a national leader in pediatric research.

Since 1990, U.S. News & World Report and its panel of board-certified pediatricians have named Childrens Hospital Los Angeles one of the top pediatric facilities in the nation.