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Telemedicine consultations increased pediatric care satisfaction in rural EDs
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Telemedicine consultations increased parent satisfaction and changes in diagnostic and therapeutic interventions compared with telephone consultations, according to recent study findings published in Critical Care Medicine.
“The bottom line is that this readily available technology can and should be used to improve the quality of care delivered to critically ill children when there are no pediatric specialists available in their own communities,” James P. Marcin, MD, MPH, director of the UC Davis Children’s Hospital Pediatric Telemedicine Program, said in a press release. “People say a picture is worth a thousand words. With medicine, video conferencing brings us right to the bedside, allowing us to see what’s happening and collaborate with on-site doctors and nurses to provide the best possible care to our patients.”
The retrospective study included 320 patients aged 0 to 17 years presenting in the highest triage category to five rural EDs with access to consultations from an academic children’s hospital. Of the participants, 58 had telemedicine consultation, 63 had telephone consultations and 199 had no pediatric specialist consultations.
The researchers found that participants who received telemedicine consultations had higher quality of care scores (5.60; 95% CI, 5.42-5.79) compared with participants who received no consultation (5.20; 95% CI, 5.07-5.34). Increased additions or changes in diagnostic study were also more prevalent with telemedicine consultations (P<.01), as well as therapeutic interventions (P<.01), compared with telephone consultations. Ninety-seven percent of parents rated overall telemedicine experience as “extremely satisfied,” 87% said it was “extremely important” for their child to receive a telemedicine consultation, and 91% of parents whose child received a telemedicine consultation said they would take part in one in the future.
“This research is important because it is one of the first published studies that has evaluated the value of telemedicine against the current standards of care from three different viewpoints — the emergency room physician; the parents of the patients; and the actual quality of care and patient outcome,” Madan Dharmar, MBBS, PhD, assistant professor in the UC Davis Children’s Hospital Pediatric Telemedicine Program, said in the release.
Disclosure: The study was funded in part by the Agency for Healthcare Research and Quality, the California Healthcare Foundation, Emergency Medical Services for Children, and the William Randolph Hearst Foundations.
Perspective
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Bryan L. Burke Jr., MD, FAAP
This study by Dharmar et al from UC-Davis provides some of the best data to date demonstrating the advantage of telemedical vs. telephone consultation when used to deliver critical care consults to children in rural emergency departments. Other studies, of a descriptive nature, have reached similar conclusions, but have not been supported by as much data. Using a previously validated implicit review instrument, two pediatric emergency medicine physicians uninvolved in the patients care reviewed the medical records to assess quality of care. Patients who received telemedical consultations received better care than those receiving telephone consultations or no consultation. In addition, telemedical consultations resulted in more diagnostic interventions and more therapeutic efforts. Finally, parents were happier with the results of the telemedicine consultations as compared with the telephone consultations.
With each passing year, more evidence accumulates supporting the ability of telemedicine to provide superior medical care. Telemedicine allows better care to be given to those living in rural and medically underserved areas. Consultations and chronic care too, as well as emergent care, can be provided in the patient’s home town, allowing them to avoid inconvenient and expensive trips to large, imposing, and confusing tertiary care centers. Physicians can enhance the patient’s medical home by providing care from their office to the patient wherever he/she may be, such as in day care, pre-school, school, or juvenile detention facilities. In addition, live interactive tele-education facilitates both the ability of physicians in practice to stay up to date and also to form virtual peer groups between themselves, their academic peers, and their private practice peers. Finally, the ability of telemedicine to increase the catchment area for research trials has only begun to be tapped. The telemedicine train is leaving the station. All aboard!
Bryan L. Burke Jr., MD, FAAP, can be reached at University of Arkansas for Medical Sciences, 4301 West Markham St., Slot 512-5B, Little Rock, AR, 72205; email: BurkeBryanL@uams.edu.
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