Telemedicine Consultations and Medication Errors in Rural Emergency Departments

OBJECTIVE: To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). METHODS: We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children’s hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. RESULTS: Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs 10.8% and 12.5%, respectively; P , .05). In hierarchical logistic regression analysis, medications for patients who received telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P , .05) or no consultations (odds ratio: 0.13, P , .05). CONCLUSIONS: Pediatric critical care telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs. Pediatrics 2013;132:1090–1097 AUTHORS: Madan Dharmar, MBBS, PhD,ab Nathan Kuppermann, MD, MPH,a,b,c Patrick S. Romano, MD, MPH,a,b,d Nikki H. Yang, DVM, MPVM,a Thomas S. Nesbitt, MD, MPH,e Jennifer Phan, PharmD,f Cynthia Nguyen, PharmD,g Kourosh Parsapour, MD, MBA,h and James P. Marcin, MD, MPHab bCenter for Healthcare Policy and Research and Departments of aPediatrics, cEmergency Medicine, dInternal Medicine, eFamily Practice and Community Medicine, and fPharmacy, University of California Davis, Sacramento, California; gDepartment of Pharmacy, University of California San Francisco, San Francisco, California; and hDepartment of Pediatrics, University of California Irvine, Irvine, California