Evidence-Based Tele-Emergency Network Grant Program

The investigators will use a novel cluster randomized unbalanced crossover trial design. When
a new site is enrolled, the first approximately 6 months of the project will be a "ramp-up"
period during which the protocol will be re-reviewed during a site visit to the participating
EDs and random block assignments will be generated and delivered. The last 6 months will be
reserved for data analysis, study closeout, and manuscript preparation. An intervening 2-year
period will be divided into 4 six-month calendar time periods for carrying out the protocol
and data collection. For each 6-month period, each ED will have a randomized treatment
assignment for pediatric emergency and critical care consultations ("M" for telemedicine and
"P" for telephone.) Participating EDs (the unit of randomization) will be stratified into two
strata by size of ED and geographical location. EDs will then be randomized within-strata to
one of the four unbalanced (3:1) crossover treatment assignment sequences, each consisting of
a 6-month period: PMMM, MPMM, MMPM, or MMMP. During these assigned periods, the type of
consultation being assigned will be strongly encouraged, but deviating from protocol (i.e.,
using telephone consultation when randomized to telemedicine, or the vice-versa) will be
allowed as needed by the physicians. Data will be collected and abstracted through
retrospective chart review.

Inclusion Criteria:

- Children younger than or equal to 14 years of age at the time of their ED visit.

Exclusion Criteria:

- Children evaluated at the ED for non-medical reasons such as elective surgeries and
social reasons (i.e., cases of possible endangerment) and other non-medical reasons.

- Children evaluated at the ED preoperatively, for elective surgical procedures.

- Children transferred to the ED from another hospital ED.

- Children transiently "held" in the ED in the process of a direct admission to the
ward.