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- Title
Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial.
- Authors
Marcin, James P.; Sauers-Ford, Hadley S.; Mouzoon, Jamie L.; Haynes, Sarah C.; Dayal, Parul; Sigal, Ilana; Tancredi, Daniel; Lieng, Monica K.; Kuppermann, Nathan
- Abstract
Key Points: Question: Does the use of telemedicine for pediatric consultations for acutely ill children to referring hospital emergency departments result in fewer interfacility transfers 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 emergency departments, the adjusted risk of transfer was significantly lower by 7% among those assigned to the telemedicine arm than those assigned to the telephone arm. The number-needed-to-treat to prevent 1 transfer was 16.5. Meaning: The use of telemedicine to conduct consultations for acutely ill children in rural and community emergency departments results in less frequent interfacility transfers than consultations done by telephone. Importance: Pediatric referral centers are increasingly using telemedicine to provide consultations to help care for acutely ill children presenting to rural and community emergency departments (EDs). These pediatric telemedicine consultations may help improve physician decision-making and may reduce the frequency of overtriage and interfacility transfers. Objective: To examine the use of pediatric critical care telemedicine vs telephone consultations associated with risk-adjusted transfer rates of acutely ill children from community and rural EDs. Design, Setting, and Participants: A cluster-randomized crossover trial was conducted between November 18, 2015, and March 26, 2018. Analyses were conducted from January 19, 2018, to July 23, 2022, 2022. Participants included acutely ill children aged 14 years and younger presenting to a participating ED in 15 rural and community EDs in northern California. Interventions: Participating EDs were randomized to use telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine:1 telephone) crossover treatment assignment sequences. Main Outcomes and Measures: Intention-to-treat, treatment-received, and per-protocol analyses were performed to determine the risk of transfer using mixed effects Poisson regression analyses with random intercepts for presenting EDs to account for hospital-level clustering. Results: A total of 696 children (392 boys [56.3%]; mean [SD] age, 4.2 [4.6] years) were enrolled. Of the 537 children (77.2%) assigned to telemedicine, 251 (46.7%) received the intervention. In the intention-to-treat analysis, patients assigned to the telemedicine arm were less likely to be transferred compared with patients assigned to the telephone arm after adjusting for patient age, severity of illness, and hospital study period (risk rate [RR], 0.93; 95% CI, 0.88-0.99). The adjusted risk of transfer was significantly lower in the telemedicine arm compared with the telephone arm in both the treatment-received analysis (RR, 0.81; 95% CI, 0.71-0.94) and the per-protocol analysis (RR, 0.79; 95% CI, 0.68-0.92). Conclusions and Relevance: In this randomized trial, the use of telemedicine to conduct consultations for acutely ill children in rural and community EDs resulted in less frequent overall interfacility transfers than consultations done by telephone. Trial Registration: ClinicalTrials.gov Identifier: NCT02877810 This cluster randomized trial examines the use of telemedicine by pediatric referral centers to reduce the frequency of interfacility transfers among acutely ill children presenting to rural and community emergency departments.
- Subjects
CALIFORNIA; MEDICAL consultation; RURAL health services; HOSPITAL emergency services; CONFIDENCE intervals; PEDIATRICS; COMMUNITY health services; HOSPITAL admission &; discharge; RANDOMIZED controlled trials; EMERGENCY medical services; RESEARCH funding; DESCRIPTIVE statistics; STATISTICAL sampling; CROSSOVER trials; ACUTE diseases; TELEMEDICINE; CHILDREN
- Publication
JAMA Network Open, 2023, Vol 6, Issue 2, pe2255770
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.55770