Appropriateness of disposition following telemedicine consultations in rural emergency departments.

OBJECTIVES: To compare the appropriateness of hospital admission in eight rural emergency departments among a cohort of acutely ill and injured children who receive telemedicine consultations from pediatric critical care physicians to a cohort of similar children who receive telephone consultations from the same group of physicians.

DESIGN: Retrospective cohort study between January 2003 and May 2012.

SETTING: Eight rural emergency departments in Northern California.

PATIENTS: Acutely ill and injured children triaged to the highest-level triage category who received either telemedicine or telephone consultations.

INTERVENTIONS: Telemedicine and telephone consultations.

MEASUREMENTS AND MAIN RESULTS: We compared the overall and stratified observed-to-expected hospital admission ratios between telemedicine and telephone cohorts by calculating the risk of admission using the second generation of Pediatric Risk of Admission score and the Revised Pediatric Emergency Assessment Tool. A total of 138 charts were reviewed; 74 children received telemedicine consultations and 64 received telephone consultations. The telemedicine cohort had fewer hospital admissions compared with the telephone cohort (59.5% vs 87.5%; p < 0.05). Although the telemedicine cohort had lower observed-to-expected admission ratios than the telephone cohort, these differences were not statistically different (Pediatric Risk of Admission II, 2.36 vs 2.58; Revised Pediatric Emergency Assessment Tool, 2.34 vs 2.57). This result did not change when the cohorts were stratified into low (below median) and high (above median) risk of admission cohorts, using either Pediatric Risk of Admission II (low risk, 18.25 vs 22.81; high risk, 1.40 vs 1.54) or Revised Pediatric Emergency Assessment Tool (low risk, 5.35 vs 5.94; high risk, 1.51 vs 1.81).

CONCLUSIONS: Although the overall admission rate among patients receiving telemedicine consultations was lower than that among patients receiving telephone consultations, there were no statistically significant differences between the observed-to-expected admission ratios using Pediatric Risk of Admission II and Revised Pediatric Emergency Assessment Tool. Our findings may be reassuring in the context of previous research, suggesting that telemedicine specialty consultations can aid in the delivery of more appropriate, safer, and higher quality of care.