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- Title
Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians: A Cluster Randomized Crossover Trial.
- Authors
Marcin, James P.; Lieng, Monica K.; Mouzoon, Jamie; Sauers-Ford, Hadley S.; Tancredi, Daniel; Cabri, Annie; Pandya, Vaibhavi A.; Park, Alex S.; Kuppermann, Nathan
- Abstract
Key Points: Question: Does the use of video telemedicine for pediatric consultations to referring hospital emergency departments (EDs) result in less frequent medication errors than the current standard of care, telephone consultations? Findings: In this cluster randomized crossover trial that included 696 acutely ill children presenting to 15 community and rural EDs, there were no statistically significant differences in physician-related medication errors between children assigned to receive telephone consultations vs video telemedicine consultations. Meaning: These findings suggest that the use of video telemedicine to conduct consultations for acutely ill children in rural and community EDs does not result in less frequent medication errors than consultations done by telephone. This cluster randomized crossover trial compares the rates of emergency department physician–related medication errors among critically ill children randomized to receive either video telemedicine or telephone consultations. Importance: Critically ill children presenting to emergency departments (EDs) in non–children's hospitals are at high risk for experiencing medical errors, including medication errors. Video telemedicine consultations with pediatric specialists have the potential to reduce the risk of medication errors beyond the current standard of care, telephone consultations. Objective: To compare the rates of ED physician-related medication errors among critically ill children randomized to receive either video telemedicine or telephone consultations. Design, Setting, and Participants: This cluster randomized, unbalanced crossover trial was conducted at 15 community EDs in northern California between September 2014 and March 2018. Analyses were conducted from May 2022 to January 2023. Participants included acutely ill children younger than 15 years presenting to a participating ED. Interventions: Participating EDs were randomized to use video telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine to 1 telephone) crossover treatment assignment sequences. Main Outcomes and Measures: Pharmacists reviewed medical records to document physician-related medication errors using a previously validated instrument. Multilevel logistic regression analyses were performed to create models with the medication order as the unit of analysis and adjusting for age, the log-transformed Revised Pediatric Emergency Assessment Tool score, and hospital study period. Results: A total of 696 patient encounters were included in the trial (mean [SD] age, 4.2 [4.6] years; median [IQR] age, 2.1 [0.5-2.1] years; 304 female [43.7%]), with 537 patient encounters (77.2%) assigned to video telemedicine and 159 patient encounters (22.8%) assigned to telephone. At least 1 physician-related medication error occurred for 87 patients (12.5%), including 20 of 159 patients (12.6%) in the telephone cohort and 67 of 537 patients (12.5%) in the telemedicine cohort. Of the 2414 medication orders, errors occurred in 124 cases (5.1%), including 26 of 513 orders (5.1%) in the telephone cohort and 98 of 1901 orders (5.2%) in the telemedicine cohort. In the multivariable analysis, the adjusted odds ratio of experiencing a medication error among those assigned to telemedicine was 0.86 (95% CI, 0.49-1.52; P =.61). Conclusions and Relevance: This cluster randomized crossover trial found no statistically significant differences in physician-related medication errors between critically ill children assigned to receive telephone consultations vs video telemedicine consultations. Trial Registration: ClinicalTrials.gov Identifier: NCT02877810
- Subjects
CLUSTER sampling; CONFIDENCE intervals; CRITICALLY ill; MEDICATION errors; PATIENTS; VIDEOCONFERENCING; ACQUISITION of data; PEDIATRICS; MANN Whitney U Test; RANDOMIZED controlled trials; PRE-tests &; post-tests; COMPARATIVE studies; MEDICAL referrals; DRUG prescribing; RESEARCH funding; MEDICAL records; DESCRIPTIVE statistics; CHI-squared test; PHYSICIANS; PHYSICIAN practice patterns; STATISTICAL sampling; CROSSOVER trials; LOGISTIC regression analysis; TELEMEDICINE; LONGITUDINAL method; CHILDREN
- Publication
JAMA Network Open, 2024, Vol 7, Issue 2, pe240275
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.0275