Telemedicine in the Pediatric ED

Does telemedicine, which dates back to space exploration in the 1970s and the need to transmit astronauts’ physiologic data, bring benefits in pediatric emergency medicine today?

Yes, answered pediatric resident Caleb Ward at a recent Hopkins Children’s Grand Rounds, citing studies spurred by the National Library of Medicine in the late 1990s. Telemedicine has been shown to increase physician-to-physician communication and efficiency and facilitate early discharge in the ED, Ward explained, while decreasing unnecessary transport and unnecessary clinic and ED visits. Benefits also include better access to subspecialists, better and faster medical decisions, and increased patient satisfaction.

“Rather than sending your patient off to some magical tertiary center and hearing weeks later, if at all, what happened to your patient,” Ward said, “telemedicine gives you the opportunity to have an interactive discussion with the emergency room physician in real time.”

Though not a pediatric patient, Ward said, the case of a 69-year-old male patient scheduled for a hip-transplant illustrates the benefits of telemedicine in emergency medicine. Although the usual pre-operative check-up done the day before was normal, a teleconsultation revealed an acute fever and a potentially serious infection. The patient was admitted to the ED and diagnosed with adenocarcinoma of the sigmoid, demonstrating that teleconsultation is not only a powerful tool for triage and diagnosis, but can also help to reduce delay in the diagnosis of a severe disease (Journal of Telemedicine and Telecare 2012;18(2):119-21).

Ward pointed to another study comparing outcomes before and after implementation of telemedicine in the management of rural trauma patients initially treated at a local community hospital. All of the pre-telemedicine patients were transported to a trauma center, while the post-telemedicine patients went to a range of healthcare facilities, and only 11 percent to a trauma center. Also, more than half of the post-telemedicine patients were sent home (Journal of Trauma 2008:Jan;64(1):92-7).

“I’m sure all of you have seen in the emergency room patients who have been transported huge distances only for the triage nurse to say ‘I’m sure we can transport this patient home,’” Ward said.

Significantly, the cost for transportation of the pre-telemedicine patients was $7.6 million, compared with $1.1 million for the post-telemedicine patients.

So, why isn’t telemedicine used more widely in emergency cases?

There are licensing and liability concerns, Ward said. If a question came up about malpractice in a cross-state consultation, and you had a physician at each end of the video, how would blame be apportioned? A greater concern, Ward said, is the reliability of telemedicine assessments.

“We’re always taught if you have any doubts about a patient see the patient yourself, feel the belly yourself and listen to the lungs yourself,” Ward explained. “This sort of runs counter to that orthodoxy we were taught in training. So if we’re going to use this, how do we effect training and efficiency in using it?”

The answer to that, Ward added, needs further research.

For more information, visit the NLM National Telemedicine Initiative.