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Telemedicine improves care for kids seen in rural ERs

By Anne Harding

NEW YORK (Reuters Health) - Telemedicine consults can help rural emergency room doctors provide better care to seriously ill or injured young patients, new research confirms.

Rural hospitals and doctors' offices are increasingly using telemedicine - essentially, videoconferencing with another doctor from a remote location - 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.

Seeking expert help can be especially vital for emergency treatment of children, Marcin added, because rural ER doctors may see only a handful of pediatric patients a year, and guidelines on how to care for them are lacking. "For a three-month-old that comes in for wheezing or for a six-month-old that comes in for a fever, there are very few evidence-based guidelines," he said.

Marcin and his colleagues worked with five rural hospitals to install telemedicine systems to help them care for young ER patients. Dedicated videoconferencing systems were set up in each rural hospital ER and in the UC Davis Children's Hospital pediatric intensive care unit, where a critical care doctor is always on duty.

To investigate whether the telemedicine consultations were improving care, the researchers looked at pediatric patients who arrived at the rural ERs in the highest triage category, meaning they needed immediate assessment and treatment. Marcin and his team gathered records for the two years before the telemedicine systems were installed in each hospital and for at least two years after the systems were installed.

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 study authors who are specialists in pediatric critical care medicine 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 versus a phone consultation, according to findings published in Critical Care Medicine.

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

"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, 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."

SOURCE: http://bit.ly/17XLWYF Critical Care Medicine, online August 7, 2013.

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