title: Tele-emergency utilization: In what clinical situations is tele-emergency activated?
abstract: BACKGROUND
  Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used.
  
  
  METHODS
  Tele-emergency log data and merged electronic medical record data from Avera Health (Sioux Falls, SD) were analysed for 60,193 emergency department (ED) encounters presenting over a two-and-a-half year period at 21 critical access hospitals using the tele-emergency service. Of these, tele-emergency was activated for 1512 ED encounters.
  
  
  RESULTS
  Analyses indicated that patients presenting at rural EDs with circulatory, injury, mental and symptoms diagnoses were significantly more likely to have tele-emergency department services activated as were patients who were transferred to another hospital. Interviews conducted with 85 clinicians and administrators at 26 rural hospitals that used this service indicated that this pattern of utilization facilitated rapid transfers and followed recommended clinical protocols for patients needing serious and/or urgent attention (e.g. stroke symptoms, chest pain).
  
  
  CONCLUSIONS
  Although only used in 3.5% of ED encounters on average, our findings provide evidence that tele-emergency activation is well reasoned and related to those situations when extra expert assistance is particularly beneficial.
authors.affiliation: Department of Health Management and Policy, University of Iowa, USA marcia-m-ward@uiowa.edu.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: Department of Health Management and Policy, University of Iowa, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Ullrich
authors.affiliation: Department of Health Management and Policy, University of Iowa, USA.
authors.forename: A Clinton
authors.initials: AC
authors.lastname: MacKinney
authors.affiliation: Avera Health, Sioux Falls, SD, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Bell
authors.affiliation: Avera Health, Sioux Falls, SD, USA.
authors.forename: Shiann
authors.initials: S
authors.lastname: Shipp
authors.affiliation: Department of Health Management and Policy, University of Iowa, USA.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*
keywords: Tele-emergency; emergency department; rural hospital; telehealth; telemedicine