Format

Send to

Choose Destination
J Telemed Telecare. 2019 Apr 9:1357633X19839610. doi: 10.1177/1357633X19839610. [Epub ahead of print]

Paediatric tele-emergency care: A study of two delivery models.

Author information

1
1 University of Iowa, Iowa City, IA, USA.
2
2 Avera eCARE, Sioux Falls, SD, USA.
3
3 University of California Davis, Davis, CA, USA.
4
4 Avera Health, Sioux Falls, SD, USA.

Abstract

INTRODUCTION:

Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one general, that provide care to paediatric populations. Through an examination of model structures and patient populations, we gain insight into how evaluative measures should reflect tele-ED model design and purpose.

METHODS:

Qualitative descriptions of the two tele-ED models are presented. We show a retrospective cohort analysis describing paediatric patients' key characteristics, reasons for visit, and disposition status by case/control status. Case/control patient encounter data were collected October 2015 through December 2017 from 15 spoke hospitals within each tele-ED program.

RESULTS:

The two tele-ED models serve distinct paediatric populations, and measures of tele-ED utilization and disposition reflect those differences. In the specialized University of California (UC) Davis Health program, tele-ED was utilized in 36% of paediatric critical care encounters and 78% of those were transferred. In the Avera eCARE program, tele-ED was activated in 1.7% of paediatric encounters and 50.6% of those were transferred. When Avera eCARE paediatric encounters were stratified by severity, measures of tele-ED use and disposition status among high-severity encounters were more similar to UC Davis Health.

DISCUSSION:

This study describes how design choices of tele-ED models have implications for evaluative measures. Measures of tele-ED model success need to reflect model purpose, populations served, and for whom tele-ED service use is appropriate.

KEYWORDS:

Telemedicine; disposition; paediatric population; rural; tele-emergency

PMID:
30966860
DOI:
10.1177/1357633X19839610

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center