title: Telemedicine consultations and medication errors in rural emergency departments.
abstract: OBJECTIVE
  To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs).
  
  
  METHODS
  We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children's hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level.
  
  
  RESULTS
  Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs. 10.8% and 12.5%, respectively; P < .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P < .05) or no consultations (odds ratio: 0.13, P < .05).
  
  
  CONCLUSIONS
  Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.
authors.affiliation: MBBS, Department of Pediatrics, University of California Davis Children's Hospital, 4610 X St, Suite 2310, Sacramento, CA 95817. mdharmar@ucdavis.edu.
authors.forename: Madan
authors.initials: M
authors.lastname: Dharmar
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.forename: Nikki H
authors.initials: NH
authors.lastname: Yang
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Jennifer
authors.initials: J
authors.lastname: Phan
authors.forename: Cynthia
authors.initials: C
authors.lastname: Nguyen
authors.forename: Kourosh
authors.initials: K
authors.lastname: Parsapour
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
mesh_terms: D002140:California; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D019114:Remote Consultation; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods*; D049269:Videoconferencing
keywords: emergency medicine; health services research; medication errors; patient safety; pediatrics; rural health; telehealth; telemedicine