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In rural ERs, kids get better care with telemedicine

UC DAVIS (US) — After a live videoconference with a specialist, rural emergency room physicians are more likely to adjust diagnosis and course of treatment for injured children, research shows.

The use of technology to link far-distant practitioners has been steadily increasing in the US, particularly as a tool to provide rural communities with access to specialty physicians.

“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,” says James Marcin, director of the Children’s Hospital Pediatric Telemedicine Program at the University of California, Davis.

“People say a picture is worth a thousand words,” says Marcin, professor of pediatrics. “With medicine, video conferencing 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.”

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.

For the new study, published online in Critical Care Medicine, 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 included 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, patients, and parents.

Fifty-eight consultations were conducted using telemedicine consultations and 63 consultations were conducted using telephone; 199 participants did not receive specialist consultations.

Satisfied parents

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.

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, says Madan Dharmar, assistant research professor in the pediatric telemedicine program and lead author of the study.

While 21 percent of children in the United States live in rural areas, only 3 percent of pediatric critical-care medicine specialists practice in such areas.

“This research is important,” Dharmar says, “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.”

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.

Other researchers from UC Davis and the University of Utah contributed to the study, which was funded by the Agency for Healthcare Research and Quality, Health Resources and Services Administration-Emergency Medical, California Healthcare Foundation grant, and the William Randolph Hearst Foundation.

Source: UC Davis

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