“We wanted to look at medication errors and see how telemedicine consultations impacted those rates, compared to telephone consultations or no consultations at all.” said Madan Dharmar, assistant research professor in the Pediatric Telemedicine Program. “We know that having a specialist treat children lowers the risk of medication errors. However, no one had ever studied whether specialists could use telemedicine to have the same effect.”
Rural physicians face distinct disadvantages when providing critical care for severely ill or injured pediatric patients. In addition to lacking pediatric specialty training and experience treating children, emergency physicians in small rural hospitals often lack access to electronic medical records, computerized order entry and 24-hour pharmacist coverage. Previous studies have confirmed that children are at greater risk when treated in rural emergency rooms.
“In children, there’s a higher risk of medication errors because the drug doses are based on weight,” said Dharmar. “Because many of these physicians are not specialists in the treatment of children, there tends to be more errors.”
The study looked at the care provided to 234 patients. In 73 cases (31 percent), a pediatric critical care specialist conferred, over a secure connection, with an emergency physician, the patient, a nurse and a parent or guardian (when available). In 85 cases (36 percent), the specialty consultations were conducted by telephone. In 76 cases (32 percent), the emergency department team received no specialist consult.
The results highlight how well these telemedicine consultations reduce medication errors. The error rate for the telemedicine group was 3.4 percent compared to 10.8 percent for telephone consultations and 12.5 percent when there were no consults. The most common errors were incorrect doses. Telemedicine patients had far fewer dosage errors.
“Our results clearly show that using telemedicine to increase specialist presence lowers the risk of medication errors among seriously ill children,” said Dharmar.
In particular, the contrast between the telemedicine and telephone error rates seems to indicate that visual interaction is a key component to improving care.
The eight rural hospitals were provided telemedicine services, high-resolution monitors and secure power supplies to facilitate the consultations. In addition, UC Davis made pediatric critical care specialists available around-the-clock to provide these consults.
To determine the error rates, researchers looked at charts from the eight hospitals. Patients were older than one day and younger than 17 years and were chosen based on their high level of illness or injury. Emergency department physicians made their own decisions on whether to take advantage of the telemedicine tools.
These findings could have a significant impact on care for all patients. According to the Institute of Medicine, hospital medical errors cause 98,000 preventable deaths each year.
“It’s a win-win for both the specialist, who can see the patients and provide better assessments and care,” said Dharmar, “and for the rural provider, who can deliver a higher level of care right there in their community.”
Other researchers in the study included Nathan Kuppermann, Patrick S. Romano, Nikki H. Yang, Thomas S. Nesbitt, Jennifer Phan and James P. Marcin from UC Davis, Cynthia Nguyen from UC San Francisco and Kourosh Parsapour from UC Irvine.
This research was funded by grants from Agency for Healthcare Research and Quality, Emergency Medical Services for Children, Office for the Advancement of Telehealth, the California Healthcare Foundation and the William Randolph Hearst Foundations.