Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial

Overview

Journal JAMA Netw Open

Publisher American Medical Association

Specialty General Medicine

Date 2023 Feb 13

PMID 36780158

Authors

James P Marcin

Hadley S Sauers-Ford

Jamie L Mouzoon

Sarah C Haynes

Parul Dayal

Ilana Sigal

Daniel Tancredi

Monica K Lieng

Nathan Kuppermann

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Telemedicine vs Telephone Consultations and Medication Prescribing Errors Among Referring Physicians: A Cluster Randomized Crossover Trial.

Marcin J, Lieng M, Mouzoon J, Sauers-Ford H, Tancredi D, Cabri A JAMA Netw Open. 2024; 7(2):e240275.

PMID: 38421649 PMC: 10905304. DOI: 10.1001/jamanetworkopen.2024.0275.

Using human-centered design to develop a nurse-to-family telehealth intervention for pediatric transfers.

Rosenthal J, Ketchersid A, Horath E, Sanders A, Harper T, Hoyt-Austin A Digit Health. 2023; 9:20552076231219123.

PMID: 38107976 PMC: 10725135. DOI: 10.1177/20552076231219123.

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