Parent Perceptions on Transfers to Pediatric Emergency Departments and the Role of Telemedicine

Abstract

Objective Real-time audiovisual consultation (telemedicine) has been proven feasible and is a promising alternative to interfacility transfer. We sought to describe caregiver perceptions of the decision to transfer his or her child to a pediatric emergency department and the potential use of telemedicine as an alternative to transfer. Methods Semistructured interviews of caregivers of patients transferred to a pediatric emergency department. Purposive sampling was used to recruit caregivers of patients who were transferred from varying distances and different times of the day. Interviews were conducted in person or on the phone by a trained interviewer. Interviews were recorded, transcribed, and analyzed using modified grounded theory. Results Twenty-three caregivers were interviewed. Sixteen (70%) were mothers; 57% of patients were transported from hospitals outside of the city limits. Most caregivers reported transfer for a specific resource need, such as a pediatric subspecialist. Generally, caregivers felt that the decision to transfer was made unilaterally by the treating physician, although most reported feeling comfortable with the decision. Almost no one had heard about telemedicine; after hearing a brief description, most were receptive to the idea. Caregivers surmised that telemedicine could reduce the risks and cost associated with transfer. However, many felt telemedicine would not be applicable to their particular situation. Conclusions In this sample, caregivers were comfortable with the decision to transfer their child and identified potential benefits of telemedicine as either an adjunct to or replacement of transfer. As hospitals use advanced technology, providers should consider families' opinions about risks and out-of-pocket costs and tailoring explanations to address individual situations.

Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service

“…Many studies examining telemedicine across settings have failed to find compelling clinical or cost benefits, 14 – 16 although patients are often satisfied with these services and remain optimistic about their potential. 17 , 18 The most successful applications of telemedicine have been subspecialty consultations in resource-limited settings. In the ED, this includes tele-neurology for acute stroke, remote radiology, 19 – 23 and psychiatric evaluations.…”

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

“…Telemedicine offers another potential means of extending pediatric expertise to additional EDs. Prior studies report that telemedicine is of interest to parents experiencing transfers, may improve evaluation quality, and may reduce illness severity among children requiring transfer, although numerous barriers still face the uptake and sustainability of pediatric emergency telemedicine programs …”

Predictors of Potentially Unnecessary Transfers to Pediatric Emergency Departments

“…Moreover, the PHIS database does not track subspecialty consultation; although we sought to mitigate this limitation by accounting for such factors as illness severity, operating room charges, and sedation, these factors do not encompass the full spectrum of pediatric consultations or reasons for transfer. 1,3,14,15,27 The lack of subspecialty consultation, as well as other factors (eg, medication administration), may limit contextualization of our findings with other similar studies on ED-to-ED transfers.…”