Aug 19, 2013

By Anne Harding

NEW YORK (Reuters Health) Aug 19 – Telemedicine consults can help rural emergency rooms provide better care to seriously ill or injured young patients, new research confirms.

Rural hospitals and doctors’ offices are increasingly using telemedicine to gain access to specialty care, Dr. James Marcin of the University of California, Davis Children’s Hospital in Sacramento, the senior author of the new study, told Reuters Health.

“It’s a great way to leverage technology to improve the quality of care that we provide,” he said.

Marcin and his colleagues worked with five rural hospitals to install dedicated videoconferencing systems in each rural hospital ER and in the UC Davis Children’s Hospital pediatric intensive care unit.

To investigate whether the telemedicine consultations were improving care, the researchers looked at data on pediatric patients who arrived at the rural ERs in the highest triage category, for the two years before the telemedicine systems were installed and for at least two years afterward.

They identified records for 320 patients, including 58 who had telemedicine consultations, 63 who had phone consultations and 199 who had no consultation. After information indicating whether a consultation had taken place was removed from the records, two specialists in pediatric critical care independently rated the quality of care provided to each patient.

The average quality of care score was 5.76 on a scale of 1 to 7 for patients who received telemedicine consults, versus 5.38 for patients who received phone consultations and 5.26 for those who received no consultation.

Parents also were more satisfied with the care provided to their child when they had received a telemedicine consultation vs a phone consultation, according to findings published online August 7th in Critical Care Medicine.

Real-time videoconferencing provides consulting doctors with far more information than a telephone call, Dr. Marcin noted.

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“We tend to spend more time on the videoconferencing calls than we do on the telephone. When I’m on a videoconferencing call I can see the child moving, I can see the monitors. There’s a lot more information that we’re gathering when we use videoconferencing than when we’re relying on what the doctor is telling us.”

In addition to improving the quality of care, Dr. Marcin added, it’s likely that telemedicine can sometimes lower unnecessary costs, too. For example, he explained, the expert consultant can help determine whether a patient needs helicopter transport to a higher-level trauma center.

“Many times if we’re able to see the kids, we can say, ‘We can use an ambulance, we can help you watch that kid, he can also be admitted locally,'” he said. “Sometimes we’ll recommend that they go to an intermediate community hospital as opposed to the big city children’s hospital.”



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