Department of Public Health Sciences

Impact of critical care telemedicine consultations on children in rural emergency departments

Dharmar M, Romano PS, Kuppermann N, Nesbitt TS, Cole SL, Andrada ER, Vance C, Harvey DJ, Marcin JP

Critical Care Medicine. 2013. 41(10):2399-2395.

OBJECTIVES: To compare the quality of care delivered to critically ill and injured children receiving telemedicine, telephone, or no consultation in rural emergency departments. DESIGN: Retrospective chart review with concurrent surveys. SETTING AND PARTICIPANTS: Three hundred twenty patients presenting in the highest triage category to five rural emergency departments with access to pediatric critical care consultations from an academic children's hospital. MEASUREMENTS AND MAIN RESULTS: Quality of care was independently rated by two pediatric emergency medicine physicians applying a previously validated 7-point implicit quality review tool to the medical records. Quality was compared using multivariable linear regression adjusting for age, severity of illness, and temporal trend. Referring physicians were surveyed to evaluate consultation-related changes in their care. Parents were also surveyed to evaluate their satisfaction and perceived quality of care. In the multivariable analysis, with the no-consultation cohort as the reference, overall quality was highest among patients who received telemedicine consultations (n = 58; β = 0.50 [95% CI, 0.17-0.84]), intermediate among patients receiving telephone consultation (n = 63; β = 0.12 [95% CI, -0.14 to 0.39]), and lowest among patients receiving no consultation (n = 199). Referring emergency department physicians reported changing their diagnosis (47.8% vs 13.3%; p



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