Paediatric tele-emergency care: A study of two delivery models

Paula A. Weigel, Kimberly A.S. Merchant, Amy Wittrock, Jamie Kissee, Fred Ullrich, Amanda L. Bell, James P Marcin, Marcia M. Ward

Research output: Contribution to journalArticle

Abstract

Introduction: Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one general, that provide care to paediatric populations. Through an examination of model structures and patient populations, we gain insight into how evaluative measures should reflect tele-ED model design and purpose. Methods: Qualitative descriptions of the two tele-ED models are presented. We show a retrospective cohort analysis describing paediatric patients’ key characteristics, reasons for visit, and disposition status by case/control status. Case/control patient encounter data were collected October 2015 through December 2017 from 15 spoke hospitals within each tele-ED program. Results: The two tele-ED models serve distinct paediatric populations, and measures of tele-ED utilization and disposition reflect those differences. In the specialized University of California (UC) Davis Health program, tele-ED was utilized in 36% of paediatric critical care encounters and 78% of those were transferred. In the Avera eCARE program, tele-ED was activated in 1.7% of paediatric encounters and 50.6% of those were transferred. When Avera eCARE paediatric encounters were stratified by severity, measures of tele-ED use and disposition status among high-severity encounters were more similar to UC Davis Health. Discussion: This study describes how design choices of tele-ED models have implications for evaluative measures. Measures of tele-ED model success need to reflect model purpose, populations served, and for whom tele-ED service use is appropriate.

Original languageEnglish (US)
JournalJournal of Telemedicine and Telecare
DOIs
StatePublished - Jan 1 2019

Keywords

  • disposition
  • paediatric population
  • rural
  • tele-emergency
  • Telemedicine

ASJC Scopus subject areas

  • Health Informatics

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    Weigel, P. A., Merchant, K. A. S., Wittrock, A., Kissee, J., Ullrich, F., Bell, A. L., Marcin, J. P., & M. Ward, M. (2019). Paediatric tele-emergency care: A study of two delivery models. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X19839610