When a child ends up in the Emergency Department (ED) at one of Pennsylvania’s rural hospitals, the emergency doctor has a tough decision to make. The doctor can either treat the child there with limited pediatric expertise or send the child to Children’s Hospital of Pittsburgh at UPMC.
Last year, more than 400 children were transferred from rural emergency departments to Children’s Hospital of Pittsburgh, a trip that can involve much travel only to be immediately discharged back to their communities. If these children were triaged via telemedicine, $800,000 could have been saved, according to data collected from the Children’s Hospital Emergency Department.
“In general, about a quarter of all pediatric emergency visits are to hospitals in rural areas, but rural hospitals rarely have the equipment and expertise necessary to provide effective emergency care to children”, said Jeremy Kahn, MD, Project Leader and Associate Professor of
Critical Care, Medicine, and Health Policy at the University of Pittsburgh’s School of Medicine and Graduate School of Public Health.
To help solve the problem, a project at the University of Pittsburgh, School of Health Sciences is using telemedicine to make that decision easier. The “Optimizing Utilization and Rural Emergency Access for Children”, or OUTREACH is a project designed to use telemedicine to be more effective in pediatric emergencies.
This project is being funded with nearly a $1 million grant from HRSA to address critical deficiencies in pediatric emergency care as reported in IOM’s report “Emergency Care for Children: Growing Pains.”
Information will be gathered from hospital administrators, physicians, nurses, emergency transport personnel, patients, and families to identify issues that surround pediatric emergency care and research how to eliminate the potential obstacles to using telemedicine in rural hospitals
This information will be used to develop a standardized educational program to help hospitals use telemedicine to improve pediatric emergency care by consulting with Children’s Hospital specialists. The team will then partner with the Pennsylvania Department of Public Welfare that oversees the state’s Medicaid program to evaluate the program.
In another part of the country, the University of California San Diego Health System’s ED is having a problem with overcrowding. The UC system is studying the issue and now uses telemedicine technology in six rooms in the ED as a way to help address this problem. This study is unique in that it is the first ED in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.
The study “Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency” or known as (ED-TITRATE) is supported by a $50,000 University of California Center for Health Quality and Innovation (CHQI) grant.
The telemedicine system enables doctors to help patients via telemedicine when the ED becomes busy. The system works when an offsite doctor is paged who then remotely links to a telemedicine station to see patients. With the help of an ED nurse, these patients are seen by telemedicine based on their arrival time and level of medical need.
Guided by high fidelity sound and video, the physician using telemedicine technologies examines the patient’s eyes, ears, nose, throat, and skin as well as listen to heart and lung sounds through the module. Laboratory and imaging tests can be ordered and results reviewed with physician ordering and documentation accomplished through an EMR.
According to David Guss MD, Chair of the Department of Emergency Medicine at UC San Diego School of Medicine, “We will continue to use the grant funding to improve the efficiency of the project and train staff. Our goal is to eventually expand this project to our emergency department in La Jolla, and if the study proves successful, potentially see it deployed in other hospital emergency departments across the country.”