title: Parent Perceptions on Transfers to Pediatric Emergency Departments and the Role of Telemedicine.
abstract: OBJECTIVE
  Real-time audiovisual consultation (telemedicine) has been proven feasible and is a promising alternative to interfacility transfer. We sought to describe caregiver perceptions of the decision to transfer his or her child to a pediatric emergency department and the potential use of telemedicine as an alternative to transfer.
  
  
  METHODS
  Semistructured interviews of caregivers of patients transferred to a pediatric emergency department. Purposive sampling was used to recruit caregivers of patients who were transferred from varying distances and different times of the day. Interviews were conducted in person or on the phone by a trained interviewer. Interviews were recorded, transcribed, and analyzed using modified grounded theory.
  
  
  RESULTS
  Twenty-three caregivers were interviewed. Sixteen (70%) were mothers; 57% of patients were transported from hospitals outside of the city limits. Most caregivers reported transfer for a specific resource need, such as a pediatric subspecialist. Generally, caregivers felt that the decision to transfer was made unilaterally by the treating physician, although most reported feeling comfortable with the decision. Almost no one had heard about telemedicine; after hearing a brief description, most were receptive to the idea. Caregivers surmised that telemedicine could reduce the risks and cost associated with transfer. However, many felt telemedicine would not be applicable to their particular situation.
  
  
  CONCLUSIONS
  In this sample, caregivers were comfortable with the decision to transfer their child and identified potential benefits of telemedicine as either an adjunct to or replacement of transfer. As hospitals use advanced technology, providers should consider families' opinions about risks and out-of-pocket costs and tailoring explanations to address individual situations.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Mollen
authors.affiliation: Drexel University School of Medicine.
authors.forename: Mira
authors.initials: M
authors.lastname: Henien
authors.affiliation: Mixed Methods Research Lab, University of Pennsylvania.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Jacobs
authors.forename: Sage
authors.initials: S
authors.lastname: Myers
mesh_terms: D000328:Adult; D017028:Caregivers; D002648:Child; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult