Telemedicine consultations significantly improve pediatric care in rural emergency rooms

August 8, 2013

Telemedicine consultations with pediatric critical-care medicine physicians significantly improve the quality of care for seriously ill and injured children treated in remote rural emergency rooms, where pediatricians and pediatric specialists are scarce, a study by researchers at UC Davis Children's Hospital has found.

The study also found that rural physicians are more likely to adjust their pediatric patients' diagnoses and course of treatment after a live, interactive videoconference with a specialist. Parents' satisfaction and perception of the quality of their child's care also are significantly improved when consultations are provided using telemedicine, rather than telephone, and aid emergency room treatment, the study found.

The research is published online today 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," said James Marcin, director of the UC Davis Children's Hospital Pediatric Telemedicine Program and the study's senior author.

"People say a picture is worth a thousand words," said Marcin, professor in the Department of Pediatrics, "With medicine, brings us right to the bedside, allowing us to see what's happening and collaborate with on-site doctors to provide the best possible care to our patients."

The use of technology to link far-distant practitioners has been steadily increasing in American medicine, particularly as a tool to provide rural and underserved communities with access to specialty physicians. More recently, telemedicine has been used for consultations to emergency rooms, and is particularly recommended for use in the area of .

Despite the expansion of telemedicine, studies of its effect on the quality of medical care remain scarce, with publications mostly limited to anecdotal reports or issues of technological feasibility and its potential to reduce health care costs. The researchers sought to measure the impact of telemedicine consultations compared to other modes of treatment, such as telephone consultations, or treatment without consultations.

The study involved 320 seriously ill or injured patients 17 years old and younger. The patients were treated at five rural Northern California emergency departments between 2003 and 2007. The rural hospitals' emergency departments were equipped with videoconferencing units to facilitate telemedicine consultations. The interactive audiovisual communications involved the rural emergency room physicians, pediatric critical-care medicine specialists at UC Davis Children's Hospital, nurses, the patients and their parents.

Fifty-eight consultations were conducted using telemedicine consultations and 63 consultations were conducted using telephone; 199 participants did not receive specialist consultations. The researchers compared the quality of care, accuracy of diagnosis and course of treatment, and overall satisfaction for all of the patients included in the study. Quality of care was evaluated using medical record review by two independent, unbiased emergency medicine physician experts.

Overall, cases involving a telemedicine consultation received significantly higher quality-of-care scores than did those involving a telephone consultation or no consultation. In addition, rural emergency room physicians were far more likely to change their diagnosis and treatment plans when consultations were provided using telemedicine, rather than telephone. Parents' satisfaction and perception of the quality of care also were significantly greater when telemedicine was used, compared to telephone guidance.

Madan Dharmar, assistant research professor in the pediatric telemedicine program and lead author of the study, said the results underscore the important role telemedicine can play in rural emergency departments, which often lack specialists and tools needed to treat pediatric patients, such as specially sized pediatric ventilators, to treat critically ill children. While 21 percent of children in the United States live in rural areas, only 3 percent of pediatric specialists practice in such areas, Dharmar said.

"This research is important," Dharmar said, "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."

He noted that future research efforts will focus on how telemedicine can affect patient safety and cut health care costs, by reducing the numbers of children unnecessarily transported to tertiary care hospitals in metropolitan areas.

Founded under Marcin's leadership, the UC Davis pediatric critical-care telemedicine program is the first of its kind in the United States. He said that, in partnership with the UC Davis Center for Health and Technology, more than 5,500 pediatric telemedicine consultations have been provided to rural hospitals throughout Northern California.

Explore further: Pilot program using telemedicine to decrease emergency room wait times

Related Stories

Pilot program using telemedicine to decrease emergency room wait times

June 12, 2013
Emergency department (ED) overcrowding has been a major issue nationally for 20 years and continues to increase in severity. To address this issue, a pilot study has been launched at UC San Diego Health System's ED to use ...

All hospital emergency rooms should be prepared for children

April 5, 2013
(HealthDay)—All hospital emergency departments (EDs), including community hospital EDs, should have the appropriate medications, equipment, policies, and staff to provide effective emergency care for children, according ...

Dermatologists find telemedicine effective for patient care

January 18, 2012
UC Davis Health System dermatologists, using videoconferencing technology known as teledemedicine, have determined that live interactive consultations can improve clinical outcomes for patients because they usually involve ...

ER referral ups specialist access for publicly insured

February 4, 2013
(HealthDay)—Specialists are more willing to see publicly insured children if they are referred from an emergency department, according to research published online Jan. 10 in the Annals of Emergency Medicine.

Pediatricians key in rural emergency medical services

October 29, 2012
(HealthDay)—In rural areas, pediatricians can play a key role in the development, implementation, and ongoing supervision of emergency medical services for children (EMSC), according to a policy statement from the American ...

Recommended for you

Study finds 275,000 calls to poison control centers for dietary supplement exposures from 2000 through 2012

July 24, 2017
U.S. Poison Control Centers receive a call every 24 minutes, on average, regarding dietary supplement exposures, according to a new study from the Center for Injury Research and Policy and the Central Ohio Poison Center, ...

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

App lets patients work alone or with others to prevent, monitor, and reverse chronic disease

July 24, 2017
Lack of patient adherence to treatment plans is a lingering, costly problem in the United States. But MIT Media Lab spinout Twine Health is proving that regular interventions from a patient's community of supporters can greatly ...

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Why sugary drinks and protein-rich meals don't go well together

July 20, 2017
Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.