69 Citations (Scopus)

Abstract

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 < 0.01) and therapeutic interventions (55.2% vs 7.1%; p < 0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures. Conclusions: Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.

Original languageEnglish (US)
Pages (from-to)2388-2395
Number of pages8
JournalCritical Care Medicine
Volume41
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Telemedicine
Critical Care
Hospital Emergency Service
Referral and Consultation
Telephone
Quality of Health Care
Physicians
Concurrent Review
Triage
Critical Illness
Medical Records
Linear Models
Parents
Pediatrics

Keywords

  • emergency medicine
  • health services research
  • implicit review
  • pediatrics
  • quality assessment
  • satisfaction
  • telemedicine

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{001bb180103e4426b644c7dce977b1a4,
title = "Impact of critical care telemedicine consultations on children in rural emergency departments",
abstract = "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 < 0.01) and therapeutic interventions (55.2{\%} vs 7.1{\%}; p < 0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures. Conclusions: Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.",
keywords = "emergency medicine, health services research, implicit review, pediatrics, quality assessment, satisfaction, telemedicine",
author = "Madan Dharmar and Romano, {Patrick S} and Nathan Kuppermann and Nesbitt, {Thomas S} and Cole, {Stacey L.} and Andrada-Brown, {Emily R} and Cheryl Vance and Harvey, {Danielle J} and Marcin, {James P}",
year = "2013",
month = "10",
doi = "10.1097/CCM.0b013e31828e9824",
language = "English (US)",
volume = "41",
pages = "2388--2395",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Impact of critical care telemedicine consultations on children in rural emergency departments

AU - Dharmar, Madan

AU - Romano, Patrick S

AU - Kuppermann, Nathan

AU - Nesbitt, Thomas S

AU - Cole, Stacey L.

AU - Andrada-Brown, Emily R

AU - Vance, Cheryl

AU - Harvey, Danielle J

AU - Marcin, James P

PY - 2013/10

Y1 - 2013/10

N2 - 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 < 0.01) and therapeutic interventions (55.2% vs 7.1%; p < 0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures. Conclusions: Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.

AB - 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 < 0.01) and therapeutic interventions (55.2% vs 7.1%; p < 0.01) more frequently when consultations were provided using telemedicine than telephone. Parent satisfaction and perceived quality were significantly higher when telemedicine was used, compared with telephone, for six of the seven measures. Conclusions: Physician-rated quality of care was higher for patients who received consultations with telemedicine than for patients who received either telephone or no consultation. Telemedicine consultations were associated with more frequent changes in diagnostic and therapeutic interventions, and higher parent satisfaction, than telephone consultations.

KW - emergency medicine

KW - health services research

KW - implicit review

KW - pediatrics

KW - quality assessment

KW - satisfaction

KW - telemedicine

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