<p><strong>OBJECTIVES: </strong>To evaluate the effect of providing early attending physician involvement via telemedicine to improve the decision process of rapid response teams.</p>

<p><strong>DESIGN: </strong>Quasi-experimental; three pairs of control/intervention months: June/July; August/October; November/December.</p>

<p><strong>SETTING: </strong>Single-center, urban, quaternary academic children's hospital with three-member rapid response team: critical care fellow or nurse practitioner, nurse, respiratory therapist. Baseline practice: rapid response team leader reviewed each evaluation with an ICU attending physician within 2 hours after return to ICU.</p>

<p><strong>SUBJECTS: </strong>1) Patients evaluated by rapid response team, 2) rapid response team members.</p>

<p><strong>INTERVENTIONS: </strong>Implementation of a smartphone-based telemedicine platform to facilitate early co-assessment and disposition planning between the rapid response team at the patient's bedside and the attending in the ICU.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>As a marker of efficiency, the primary provider outcome was time the rapid response team spent per patient encounter outside the ICU prior to disposition determination. The primary patient outcome was percentage of patients requiring intubation or vasopressors within 60 minutes of ICU transfer. There were three pairs of intervention/removal months. In the first 2 pairs, the intervention was associated with the rapid response team spending less time on rapid response team calls (June/July: point estimate -5.24 min per call; p &lt; 0.01; August/October: point estimate -3.34 min per call; p &lt; 0.01). During the first of the three pairs, patients were significantly less likely to require intubation or vasopressors within 60 minutes of ICU transfer (adjusted odds ratio, 0.66; 95 CI, 0.51-0.84; p &lt; 0.01).</p>

<p><strong>CONCLUSIONS: </strong>Early in the study, more rapid ICU attending involvement via telemedicine was associated with rapid response team providers spending less time outside the ICU, and among patients transferred to the ICU, a significant decrease in likelihood of patients requiring vasopressors or intubation within the first 60 minutes of transfer. These findings provide evidence that early ICU attending involvement via telemedicine can improve efficiency of rapid response team evaluations.</p>

<p><strong>OBJECTIVES: </strong>Millions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children's Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers.</p>

<p><strong>SETTING: </strong>76 participating centres who provide primary and secondary care in Kweneng District, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>Doctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment.</p>

<p><strong>METHODS: </strong>Retrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study.</p>

<p><strong>RESULTS: </strong>211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p&lt;0.0001), and loss of retention was observed (-1.60±0.67/month, p=0.018). IMCI training demonstrated no significant effect on acquisition (+3.58±2.84, p=0.211 or retention (+0.20±0.91/month, p=0.824) of knowledge. On average, nurses scored lower than physicians (-19.39±3.30, p&lt;0.0001). Lost to follow-up had a significant impact on knowledge retention (-3.03±0.88/month, p=0.0007).</p>

<p><strong>CONCLUSIONS: </strong>aHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.</p>