WHAT'S KNOWN ON THIS SUBJECT: Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors. WHAT THIS STUDY ADDS:The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs. abstract 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.

From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations.

Although the overall admission rate among patients receiving telemedicine consultations was lower than that among patients receiving telephone consultations, there were no statistically significant differences between the observed-to-expected admission ratios using Pediatric Risk of Admission II and Revised Pediatric Emergency Assessment Tool. Our findings may be reassuring in the context of previous research, suggesting that telemedicine specialty consultations can aid in the delivery of more appropriate, safer, and higher quality of care.

WHAT'S KNOWN ON THIS SUBJECT:Previous research has demonstrated that family presence alongside hospitalized patients is associated with improvements in physiologic responses, reductions in anxiety, and expedited recovery. Recently, videoconferencing has been increasingly used for virtual visits to pediatric patients and their parents during hospitalization.WHAT THIS STUDY ADDS: Our study demonstrates that in some cases, the use of videoconferencing by children and their parents for virtual visits is associated with greater reductions in stress during hospitalization compared with children and parents who do not use videoconferencing.abstract OBJECTIVES: Family-Link is a videoconferencing program that allows hospitalized children and their parents to virtually visit family members and friends using laptops, webcams, and a secure Wi-Fi connection. We evaluated the association of Family-Link use on the reduction in stress experienced by children during hospitalization. METHODS:We offered Family-Link to pediatric patients who had an expected length of hospitalization equal to or greater than 4 days. We measured the stress levels of hospitalized children at admission and discharge using the previously published Parental Stress Survey. We used propensity score matching and multivariable linear regression methods to evaluate the relationship between the use of Family-Link and stress experienced by children during hospitalization. RESULTS:We included a total of 367 children in the study: 232 FamilyLink users and 135 non-Family-Link users. Using the propensity score matching method, we found that the use of Family-Link was significantly associated with a greater reduction in overall mean stress compared with non-Family-Link users among the cohort of patients who lived closer to the hospital and had shorter lengths of hospitalization (b = 0.23; 95% confidence interval, 0.03 to 0.43; P , .05). In this cohort, the reduction in overall mean stress was 37% greater among Family-Link users than non-Family-Link users. CONCLUSIONS:The use of videoconferencing by some hospitalized children and families to conduct virtual visits with family and friends outside of the hospital was associated with a greater reduction in stress during hospitalization than those who did not use videoconferencing. Dr Yang conceptualized and designed the study, coordinated the data collection process, completed the analyses, interpreted the results, and drafted the initial manuscript; Dr Dharmar conceptualized and designed the study, coordinated the data collection process, assisted with the analyses, interpreted the results, and revised the manuscript; Ms Hojman assisted with the data collection process, assisted with the analyses, and critically reviewed the manuscript; Ms Sadorra coordinated the data collection process, assisted with the analyses, and critically reviewed the manuscript; Ms Sundberg coordinated the data collection process and critically reviewed the manuscript; Mr Wold assisted with the data collection process and critically reviewed t...