Emergency departments in rural areas seldom have access to physicians who specialize in pediatric care. Consequently, when a child suffering from an acute condition comes to one of these healthcare clinics seeking medical attention, they are usually transferred to a regional hospital that is able to offer more comprehensive pediatric care.
While rural and community emergency departments may lack the capacity to treat these patients, studies have shown that transferring patients to another facility is not always necessary. It can be costly for patients and their families, especially when the child is transported to facilities located hours away. Transferring a patient to another facility may be associated with an increased safety risk and poorer outcomes compared to patients who are not transferred to alternative healthcare facilities.
Telemedicine’s effect on patient transfer rates
A recent study conducted by researchers from UC Davis Health shows that critical care telemedicine consultations between specialized pediatricians and clinicians in rural and community emergency departments can reduce the number of patients transferred from local emergency departments to regional healthcare facilities to receive specialized care.
According to the study’s lead author, James Marcin, this is the first randomized clinical trial to compare the impact of telemedicine vs telephone consultations (the current standard) on patient transfer rates to facilities offering more specialized care.
Previous studies conducted by Marcin suggested that telemedicine improved the quality of care in rural and community emergency departments, as well as their transfer decisions, leading to an improved level of satisfaction for both parents and providers. Considering that more than 50% of all emergency departments across the country now make use of telemedicine, pediatric specialists can use this technology to assess remote patients visually, enabling them to make a medical diagnosis and recommendations based on their visual assessment of the patient, just as if they were examining them in the same room.
Study design
For the study, which was recently published in the Journal of the American Medical Association (JAMA) Open Network, the researchers evaluated the outcomes of a two-year clinical trial where 15 rural and community emergency departments in Northern California randomly conducted telemedicine or telephonic consultations with pediatric care specialists.
Telemedicine consultations were conducted via a high-resolution videoconferencing telemedicine camera featuring a pan-tilt zoom, mounted on a pole. This setup provided high-definition video conferencing over the internet.
The study assessed whether, following a pediatric critical care consultation, a child was transferred to UC Davis Children’s Hospital — the only nationally ranked comprehensive hospital for children in the Sacramento region. The hospital provides infants, children and adolescents with primary, subspecialty and critical care, and it is the only pediatric referral center in the region for children with highly acute health conditions.
UC Davis Children’s Hospital pediatric critical care physicians are available 24 hours daily to provide telephonic and telemedicine emergency and critical care consultations to clinicians. They provide this service to clinicians treating children in remote emergency departments to benefit patient management and to facilitate transfers between healthcare facilities when necessary.
For the study, the researchers included all children aged 14 or younger who visited a participating emergency department with an acute health condition (except physical trauma) that resulted in a remote consultation with a pediatric critical care physician from UC Davis Children’s Hospital. Children with acute physical trauma were excluded from the study because these consultations are directed to pediatric trauma specialists.
During telemedicine consultations, a visual assessment and physical examination of the patient was conducted in the presence of the referring physician, the patient’s nurse, and respiratory therapist, as well as the patient’s parents or guardians, if available.
Results
Telemedicine reduced the number of interfacility transfers. In total, 696 children (392 boys and 304 girls) with an overall average age of between four and four-and-a-half years took part in the study. The researchers found that 90.6% of patients that received telephonic consultations with a remote pediatric care specialist were transferred to UC Davis Children’s Hospital, compared to 84% of patients who received a remote telemedicine consultation.
According to Marcin, these findings show that by making use of relatively low-cost telemedicine technology, clinicians in rural and community emergency departments can successfully evaluate, treat, and either discharge the patient, or admit the child locally from their rural and community hospitals.
Marcin says these findings are important because they show that telemedicine can help clinicians in rural and community emergency departments care for pediatric patients locally, rather than having to transfer them to distant hospitals for specialist care—which may involve safety risks as well as transportation difficulties for the patient’s family.
Potential solution to specialist shortages
Nathan Kuppermann, a senior author of the study, told the press that the findings show that telemedicine can play a vital role in improving pediatric healthcare across the United States, in light of ongoing physician shortages.
“There are not nearly sufficient numbers of pediatric emergency medicine physicians to staff even a fraction of the emergency departments in this country,” Kuppermann pointed out, speaking to the press. He explained that telemedicine addresses this problem, because it enables real-time access to pediatric emergency medical expertise to assist with clinical management, inform admission decisions, and prevent unnecessary transfers.