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A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine
Ji Won Kim1, Gunjan Tiyyagura2, Melissa Langhan2
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
Insights
General emergency department (ED) providers see potential for pediatric telemedicine to improve care, identifying uses in diagnosis and consultation. However, they also noted implementation barriers and limited current experience with telemedicine in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Telehealth
Background:
- General emergency departments (EDs) often lack specialized pediatric resources.
- Telemedicine is increasingly used in various medical settings and shows promise for pediatric care.
- There's a need to address disparities in accessing pediatric emergency care.
Purpose of the Study:
- To explore general ED providers' experiences with telemedicine.
- To understand their perceptions of a potential pediatric emergency video telemedicine program.
Main Methods:
- Qualitative study using semistructured interviews.
- Purposeful sample of 18 general ED providers from 3 Connecticut hospitals.
- Grounded theory approach for data analysis, including independent coding and theme development.
Main Results:
- Providers have limited practical telemedicine experience, though familiar with its use in adult stroke care.
- Identified potential uses include guiding diagnosis/management, visual assessment, and subspecialty consultation.
- Recognized limitations such as infrequent need and implementation barriers.
Conclusions:
- General ED providers perceive significant potential for pediatric emergency video telemedicine.
- Several limitations and implementation barriers were identified.
- Further research on actual practice, patient outcomes, and cost-effectiveness is recommended before widespread adoption.
Objective:
Most children in the United States are evaluated in general emergency departments (ED), which are staffed by practitioners who care for both adults and children and may have limited pediatric resources. The application of telemedicine in pediatrics is growing and has been shown to be effective in outpatient as well as critical care settings. Telemedicine has the potential to address disparities in access to pediatric emergency care. The objective of this study was to explore experiences of general ED providers with telemedicine and their perception about a potential video telemedicine program with pediatric ED providers.
Methods:
Using qualitative methods, a purposeful sample of general ED providers (attending physicians and physician assistants) in 3 Connecticut hospitals participated in audio-recorded semistructured interviews. In line with grounded theory, 3 researchers independently coded transcripts, collectively refined codes, and created themes. Data collection and analysis continued in an iterative manner, past the point of theoretical saturation.
Results:
Eighteen general ED providers were interviewed. Three themes were identified: (a) familiarity with use in adult stroke patients but limited practical experience with telemedicine; (b) potential uses for pediatric telemedicine (guiding pediatric differential diagnosis and management, visual diagnosis, alleviating provider fears, low-frequency high-stakes events, determining disposition, assessing level of illness, and access to subspecialty consultation); and (c) limitations of telemedicine (infrequent need and implementation barriers).
Conclusions:
General ED providers identified 7 specific potential uses of pediatric emergency video telemedicine. However, they also identified several limitations of telemedicine in caring for pediatric emergency patients. Further studies after implementation of telemedicine program and comparing provider perceptions with actual practice may be helpful. Furthermore, studies on telemedicine's effect on patient-related outcomes and studies on cost-effectiveness might be necessary before the widespread implementation of a telemedicine program.
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