Pediatric Telemedicine Use in United States Emergency Departments

Abstract

Introduction: The receipt of remote clinical care for children via telecommunications (pediatric telemedicine) appears to improve access to and quality of care in U.S. emergency departments (EDs), but the actual prevalence and characteristics of pediatric telemedicine receipt remain unclear. We determined the prevalence and current applications of pediatric telemedicine in U.S. EDs, focusing on EDs that received telemedicine from clinicians at other facilities.

Methods: We surveyed all 5,375 U.S. EDs to characterize emergency care in 2016. We then randomly surveyed 130 (39%) of the 337 EDs who reported receiving pediatric telemedicine. The second survey was administered by phone to ED directors primarily. It confirmed that the ED received pediatric telemedicine services in 2017 and asked about ED staffing and the nature, purpose, and concerns with pediatric telemedicine implementation.

Results: The first survey (4,507/5,375, 84% response) showed that 337 (8%) EDs reported receiving pediatric telemedicine. Among the randomly sampled EDs completing the second survey (107/130, 82% response), 96 (90%) confirmed 2016 use and 89 (83%) confirmed 2017 use. Reasons for discontinuation included technical and scheduling concerns. Almost all who confirmed their pediatric telemedicine use in 2017 also reported 24/7 availability (98%). The most widely reported use was for patient placement and transfer coordination (80%). Many EDs (39%) reported no challenges with implementing pediatric telemedicine and described its utility. However, the most frequently reported challenges were process concerns (30%), such as concerns about slowing or interrupting providers' work flow and technological concerns (14%).

Conclusion: Few EDs receive telemedicine for the delivery of pediatric emergency care nationally. Among EDs that do use telemedicine for pediatric care, many report process concerns. Addressing these barriers through focused education or interventions may support EDs in further developing and optimizing this technological adjunct to pediatric emergency care.

Figure 1.

Pediatric telemedicine use in U.S. EDs. (A) Applications of pediatric telemedicine use in U.S. EDs (n = 88). ED respondents selected all applicable applications. Write-in responses of “other” applications included neonatal resuscitation, pharmacy assistance, and orthopedics. (B) Conditions diagnosed and treated with pediatric telemedicine in U.S. EDs (n = 67). Figure excludes those that did not report using pediatric telemedicine to diagnose or treat any conditions (n = 21). ED respondents selected all applicable conditions. Bars within each condition are mutually exclusive, representing the percentage of responding EDs that used pediatric telemedicine to 1) only diagnose that condition, 2) only treat that condition, or 3) both diagnose and treat that condition.