Telemedicine May Reduce Doctor Errors for Kids in Rural EDs‏

Laurie Barclay, MD

November 25, 2013

Use of telemedicine for pediatric critical care consultations in rural emergency departments (EDs) was associated with fewer physician-related medication errors among seriously ill and injured children, according to a study published in the November 25 issue of Pediatrics.

"Medication errors occur frequently among pediatric patients, particularly those treated in rural [EDs]," write Madan Dharmar, MBBS, PhD, an assistant research professor from the Center for Healthcare Policy and Research and Department of Pediatrics at the University of California Davis in Sacramento, and colleagues. "Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors."

Therefore, the researchers compared the frequency of physician-related medication errors among seriously ill and injured children in 8 rural EDs whose treating physician had telemedicine consultations, telephone consultations, or no consultations with pediatric critical care physicians at an academic children's hospital.

The telemedicine consultations used a turnkey videoconferencing unit but no peripheral devices such as digital stethoscopes, otoscopes, or ophthalmoscopes.

Using a previously published instrument, 2 pediatric pharmacists independently identified physician-related ED medication errors, analyzed by medication administered. Hierarchical logistic regression allowed adjustment for age, risk for hospital admission, year of consultation, hospital, and clustering at the patient level.

Telemedicine Linked to Fewer Physician Errors

Of 234 patient records reviewed, 73 included telemedicine consultations, 85 included telephone consultations, and 76 included no specialist consultations. There were significantly fewer physician-related medication errors for patients who received telemedicine consultations (3.4%) compared with those who received telephone consultations (10.8%) or no consultations (12.5%; P < .05). Dosing errors were the most common type of error.

Hierarchical logistic regression analysis showed lower odds of physician-related medication errors for patients who received telemedicine consultations than for those who received telephone consultations (odds ratio, 0.19; P < .05) or no consultations (odds ratio, 0.13; P < .05).

"The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children," the study authors write. "Therefore, this model of care may improve patient safety in rural hospital EDs."

Limitations of this study include its reliance on retrospective chart review and potential selection or confounding bias. In addition, the study could not assess the effect of telemedicine consultation on intercepted errors or determine the time of consultations in relation to the medication errors.

"[R]eduction in medication errors can potentially lead to improved outcomes and/or lower health care costs, although our study does not directly address these questions," the authors conclude. "Consequently, the use of telemedicine to provide pediatric specialty consultations may be a means to improve patient access to specialists and increase safety for seriously ill or injured children receiving emergency care in rural, underserved hospitals."

The Agency for Healthcare Research and Quality, Emergency Medical Services for Children, the Office for the Advancement of Telehealth, the California Healthcare Foundation, and the William Randolph Hearst Foundation supported this study. The authors have disclosed no relevant financial relationships.

Pediatrics. 2013;132:1090-1097.

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