Impact of critical care telemedicine consultations on children in rural emergency departments.
OBJECTIVE
To compare the quality of care delivered to critically ill and injured children receiving telemedicine, telephone, or no consultation in rural emergency departments.


METHODS
Retrospective chart review with concurrent surveys.


METHODS
Three hundred twenty patients presenting in the highest triage category to five rural emergency departments with access to pediatric critical care consultations from an academic children's hospital.


RESULTS
Quality of care was independently rated by two pediatric emergency medicine physicians applying a previously validated 7-point implicit quality review tool to the medical records. Quality was compared using multivariable linear regression adjusting for age, severity of illness, and temporal trend. Referring physicians were surveyed to evaluate consultation-related changes in their care. Parents were also surveyed to evaluate their satisfaction and perceived quality of care. In the multivariable analysis, with the no-consultation cohort as the reference, overall quality was highest among patients who received telemedicine consultations (n=58; β=0.50 [95% CI, 0.17-0.84]), intermediate among patients receiving telephone consultation (n=63; β=0.12 [95% CI, -0.14 to 0.39]), and lowest among patients receiving no consultation (n=199). Referring emergency department physicians reported changing their diagnosis (47.8% vs 13.3%; p<0.01) and therapeutic interventions (55.2% vs 7.1%; p<0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures.


CONCLUSIONS
Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.
1Department of Pediatrics, UC Davis, Sacramento, CA. 2Center for Healthcare Policy and Research, UC Davis, Sacramento, CA. 3Department of Internal Medicine, UC Davis, Sacramento, CA. 4Department of Emergency Medicine, UC Davis, Sacramento, CA. 5Department of Family Practice and Community Medicine, UC Davis, Sacramento, CA. 6Department of Surgery, University of Utah, School of Medicine, Salt Lake City, UT. 7Department of Public Health Sciences, UC Davis, Sacramento, CA.
Madan
M
Dharmar
Patrick S
PS
Romano
Nathan
N
Kuppermann
Thomas S
TS
Nesbitt
Stacey L
SL
Cole
Emily R
ER
Andrada
Cheryl
C
Vance
Danielle J
DJ
Harvey
James P
JP
Marcin
D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003422:Critical Care / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006780:Hospitals, Rural; D006801:Humans; D016014:Linear Models; D008297:Male; D008485:Medical Audit; D019114:Remote Consultation; D012189:Retrospective Studies; D013030:Spain; D017216:Telemedicine