Telemedicine Consultations and Quality of Care

Abstract

Research Article| December 01 2013 Telemedicine Consultations and Quality of Care AAP Grand Rounds (2013) 30 (6): 67. https://doi.org/10.1542/gr.30-6-67 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Telemedicine Consultations and Quality of Care. AAP Grand Rounds December 2013; 30 (6): 67. https://doi.org/10.1542/gr.30-6-67 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: care of intensive care unit patient, quality of care, telemedicine Source: Dharmar M, Romano PS, Kuppermann N, et al. Impact of critical care telemedicine consultations on children in rural emergency departments. Crit Care Med. 2013; 41(10): 1– 8; doi: https://doi.org/10.1097/CCM.0b013e3128e9824Google Scholar Investigators from the University of California-Davis studied the impact of critical care telemedicine consultation on the quality of pediatric emergency care to seriously ill or injured children. The investigators conducted the study at 5 rural emergency departments (ED) that each averaged 10 to 30 annual visits by critically ill children. Each ED had a dedicated telemedicine system installed between 2003 and 2007 which enabled videoconferencing with a critical care physician at an academic children’s hospital. The videoconferencing unit provided live, bidirectional video; peripheral devices such as digital stethoscopes, otoscopes, or ophthalmoscopes were not used. Use of telemedicine was at the discretion of the treating ED physician. The ED medical records of children aged 1 day to 17 years presenting to the participating EDs in the highest triage category were retrospectively reviewed for demographic, diagnostic, and physiologic data. Charts were categorized into 3 groups: those in which the treating ED physician utilized telemedicine consultation during the child’s care, those in which the treating ED physician utilized a standard critical care telephone consultation, and those in which the treating ED physician did not utilize either type of critical care consultation. The primary outcome was the quality of ED care received by children in each cohort. This was assessed by having two ED physicians independently review and score each encounter using a 7-point quality of care scale. Quality of care scores were compared between the different groups. Secondary outcomes included assessment of changes in ED care with critical care consultation, as measured by a postconsultation survey completed by the treating ED physician, and parent satisfaction with ED care. The medical records of 320 children were reviewed; 58 cases involved telemedicine consultation, 63 used telephone consultation, and 199 had no consultation. Quality of care scores were significantly higher for ED visits that utilized telemedicine consultation compared to no consultation (5.60 vs 5.20), which remained significant in adjusted analyses accounting for age, severity of illness, and temporal trend. In both unadjusted and adjusted analyses, there was no significant difference in quality of care scores between ED visits that used telephone consultation and those that used no consultation. The difference in quality of care scores for cases involving telemedicine versus telephone consultation was of borderline statistical significance (P = .05). ED physicians reported changing their diagnosis and therapeutic interventions significantly more frequently when consultations were provided using telemedicine compared to telephone. Parents reported significantly higher satisfaction on 6 of 7 satisfaction measures when telemedicine was used compared to telephone. The authors conclude that telemedicine consultation has the potential to resolve disparities in the quality of care provided across EDs. Dr Burke has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use... You do not currently have access to this content.