Telemedicine consults may reduce errors at rural ERs

Emergency rooms in rural areas don't see many very sick or badly injured children each year. When they do, bringing in a pediatric critical care specialist by videoconference to help with treatment could prevent errors, a new study suggests.

Researchers found rural ER doctors made errors in administering medication - such as giving the wrong dose or the wrong drug altogether - just 3 percent of the time when they used so-called telemedicine to connect with a specialist.

That compared to an 11 percent error rate when local doctors talked with a specialist by phone and a 13 percent error rate when they didn't consult with a specialist at all.

"We know that we make a difference by being able to see the patient," Dr. James Marcin said. The study's senior author, he is on the telemedicine team at the University of California Davis Children's Hospital in Sacramento.

Comparing telemedicine to a phone consultation, Marcin said, "It's the difference between the doctor coming in to do an office visit with you with his or her eyes closed, versus with his or her eyes open."

During a telemedicine conference, specialists also tend to get more involved in the patient's care and may be more likely to speak up about their treatment opinion, Marcin said.

For the new study, he and his colleagues looked at data on 234 children with severe illnesses and injuries who were seen at one of eight rural hospital ERs in Northern California between 2003 and 2009.

Those rural hospitals were small and the only hospital in their vicinity.

The ERs were participating in a larger study on telemedicine. Rural doctors could use a video conferencing unit to consult with pediatric critical care specialists like Marcin whenever they chose.

Telemedicine was used for 73 of the sick or injured children. For another 85 patients, local doctors consulted with a specialist over the phone. For the remaining 76 kids, they did not ask for help.

Local doctors gave 72 percent of all children at least one medication while they were in the ER, according to the findings published in Pediatrics.

Among cases when doctors used telemedicine, they gave children a total of 146 medications. Five of those were the wrong drug for the child's condition or were administered incorrectly.

In comparison, there were 18 errors out of 167 medications given to children when doctors consulted a specialist over the phone. And there were 16 errors out of the 128 drugs administered when there was no consultation.

"The amount of information that you can gather in a telemedicine consultation is typically much richer than what you can gather from a telephone conversation," Dr. Alejandro J. Lopez-Magallon said.

"Also, the level of interaction with the remote care team widens because you're not talking with a single person on the other side - you can interact with the remote physician or physicians and nursing staff, support staff and the patient and family themselves," he said.

Lopez-Magallon studies telemedicine at the Children's Hospital of Pittsburgh of UPMC but wasn't involved in the new study. He said it "supports, in this case, the use of this technology to improve patient care."

The researchers could not tell whether fewer medication errors meant sick and injured children fared better in the end. They also didn't know if doctors administered the drugs before or after conferencing or calling a specialist.

Although this is one example of telemedicine, the researchers said it is more often used during outpatient visits - such as to connect with a specialist from a remote primary care doctor's office.

"Telemedicine is becoming more and more mainstream, compared to what it was a decade back," Dr. Madan Dharmar, the new study's lead author, said. He is also from the UC Davis Children's Hospital.

Marcin said in his team's experience, telemedicine consultations cost about $2,000 each, including the price of the equipment.

But if the consultations can save a couple of emergency helicopter transfers to a larger hospital, they will more than pay for themselves, the researchers said. They are currently working on those cost analyses.