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27 Emergency department physicians’ recommendations for quality improvement on a paediatric tele-emergency program

Purpose of study Telemedicine is increasingly used, however, little is known about when telemedicine is most effective and how physicians’ perceive the user experience and clinical impact. The UC Davis Children’s Hospital is conducting a multi-centre randomised controlled trial to determine the impact of paediatric tele-emergency consultations provided to 15 rural EDs. As part of this study, we sought to measure the ED physicians’ opinions on using tele-emergency medicine for critically ill children. Methods used We conducted a systematic literature review on the use of paediatric tele-ED consultations and assessment tools used to evaluate telemedicine. Based on this information and potential knowledge gaps, we created a survey to assess ED physicians’ opinions on various aspects of tele-emergency medicine. The survey consisted of 27 questions: 17 based on a 7-point likert scale, and 10 open-ended and closed-ended. We sent the electronic survey to the 15 spoke hospital ED physician directors and 12 hospitals responded. Data was collected over a 3 week period in September 2017. Summary of results The most common barriers affecting telemedicine activation are limited time (30%), adoption of new technology in the existing workflow (25%) and the feeling that it is not always clinically necessary (25%). When asked about the positives of telemedicine, the majority felt that telemedicine helps with the clinical management of patients (52%) and that the patients/families like telemedicine (30%). With regards to the negatives of telemedicine, 50% of ED directors felt telemedicine is not always clinically necessary and 25% commented that it was time consuming. In open ended questions, telemedicine was frequently noted to be most effective for respiratory issues, neonatal care, and more urgent cases, and least effective for stable patients and those being transferred for specialty care. Conclusions These findings provide evidence that ED physicians believe that telemedicine helps in the clinical management of patients, most frequently among children with respiratory, congenital and cardiovascular processes. However, physicians do not consistently believe that telemedicine is clinically necessary for all cases, and least helpful among patients with non-acute/general paediatric processes.