Usage of Pediatric Telehealth by US Emergency Departments in 2019

ABSTRACT

Study Objectives: Though a growing number of EDs receive telehealth services to care for pediatric patients, little is known about the recent usage of pediatric telehealth across all US EDs. Building upon our prior work, we aimed to characterize the usage of ED pediatric telehealth in the pre-COVID-19 era. Methods: The 2019 National ED Inventory (NEDI)-USA survey characterized all US EDs open in 2019. Among EDs reporting receipt of pediatric telehealth services (n=469), we selected a random sample (n=130) for a second, in-depth survey on pediatric emergency care and pediatric telehealth usage (2019 Pediatric Telehealth Survey). We also recontacted a random sample of EDs that responded to a prior, similar 2017 Pediatric Telehealth Survey (n=107), for a total of 237 EDs in the final 2019 Pediatric Telehealth Survey sample. Descriptive statistics are presented as frequencies and proportions. Results: Overall, 193 (81%) of the 237 EDs responded to the 2019 Pediatric Telehealth Survey. Among the 107 EDs first surveyed in 2017, 89 (83%) responded to the 2019 survey. Among these 89 EDs, 63 (71%) reported receiving receiving pediatric telehealth in both 2017 and 2019, 1 (1%) in 2019 only, and 13 (15%) in 2017 only. Among the 130 EDs only surveyed in 2019, 104 (80%) responded and 85 (82%) confirmed their receipt of pediatric telehealth. Overall, 149 responding EDs confirmed pediatric telehealth receipt in 2019. Among these, few reported ever having a board-certified pediatric emergency medicine (PEM) physician (10%) or pediatrician (9%) available for emergency care. 60% reported using pediatric telehealth services less than once per month, and 20% reported using services every 3-4 weeks, although 96% reported that these services were available 24 hours per day, 7 days per week. Most received pediatric telehealth from either another hospital in their hospital system (39%) or a hospital in a different hospital system (38%). EDs most frequently used pediatric telehealth to assist with diagnosis (73%) and treatment (78%) of pediatric conditions, and with placement and transfer coordination (91%). Almost all (93%) reported using pediatric telehealth to evaluate children (1-17.9 years) and 62% for infants (<1 year). Among the 63 EDs that confirmed pediatric telehealth receipt in both 2017 and 2019, there was an increase in EDs using pediatric telehealth for diagnosis of pediatric conditions (+7%), placement and transfer coordination (+11%), and staff education (+13%). There was also an increase in EDs using pediatric telehealth to evaluate both children (+12%) and infants (+11%). Conclusion: Most EDs receiving pediatric telehealth in 2019 had no board-certified PEM physician or pediatrician available, suggesting that telehealth services are being used to supplement access to pediatric expertise. Most EDs used pediatric telehealth services infrequently. The most common usage of pediatric telehealth was for placement and transfer coordination. We encourage future research on the effect of the COVID-19 pandemic on national usage of ED pediatric telehealth.