Telemedicine consultations and medication errors in rural emergency departments
Madan Dharmar1, Nathan Kuppermann, Patrick S Romano
1MBBS, Department of Pediatrics, University of California Davis Children's Hospital, 4610 X St, Suite 2310, Sacramento, CA 95817. mdharmar@ucdavis.edu.
Insights
Telemedicine consultations for critically ill children in rural emergency departments significantly reduced physician-related medication errors compared to telephone or no consultations.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Medical Informatics
Background:
- Rural emergency departments (EDs) face challenges providing specialized care to critically ill children.
- Access to pediatric critical care specialists is often limited in rural settings.
- Medication errors are a significant concern in pediatric emergency care.
Purpose of the Study:
- To compare physician-related medication errors in seriously ill children receiving telemedicine, telephone, or no specialist consultations in rural EDs.
- To evaluate the impact of telemedicine on medication safety in pediatric emergency care.
- To identify strategies for improving care for critically ill children in remote areas.
Main Methods:
- Retrospective chart review of 234 seriously ill and injured children in 8 rural EDs.
- Independent identification of physician-related medication errors by two pediatric pharmacists.
- Hierarchical logistic regression analysis adjusting for patient and hospital-level covariates.
Main Results:
- Telemedicine consultations were associated with significantly fewer physician-related medication errors (3.4%) compared to telephone (10.8%) or no consultations (12.5%).
- Odds of medication errors were substantially lower with telemedicine (OR 0.19 for telephone, OR 0.13 for no consultation).
- Analysis adjusted for age, admission risk, consultation year, and hospital clustering.
Conclusions:
- Pediatric critical care telemedicine consultations significantly reduce the risk of physician-related medication errors in rural EDs.
- Telemedicine is an effective tool for enhancing medication safety in pediatric emergency care.
- Implementing telemedicine can improve the quality of care for critically ill children in underserved areas.
Objective:
To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs).
Methods:
We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children's hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level.
Results:
Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs. 10.8% and 12.5%, respectively; P < .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P < .05) or no consultations (odds ratio: 0.13, P < .05).
Conclusions:
Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.
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