title: The impact of the TelEmergency program on rural emergency care: An implementation study.
abstract: Introduction Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations. Methods Methods included a before and after study of the effect of the TE program on participating rural hospitals between January 2007 and December 2008. Data on ED and hospital operations were collected one year prior to and one year following the implementation of TE. Data from participating hospitals were combined and compared for the two time periods. Results Nine hospitals met criteria for inclusion and participated in the study. Total ED volumes did not significantly change with TE implementation, but ED admissions to the same rural hospital significantly increased following TE implementation (6.7% to 8.1%, p-value = 0.02). Likewise, discharge rates from the ED declined post-initiation (87.1% to 80.0%, p-value = 0.003). ED deaths and transfer rates showed no significant change, while the rate of patient discharge against medical advice significantly increased with TE use. Discussion In this analysis, we found a significant increase in the rate of ED admissions to rural hospitals with TE use. These findings may have important implications for the quality of emergency care in rural areas and the sustainability of rural hospitals' EDs.
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sterling
authors.affiliation: 2 Center for Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Samantha R
authors.initials: SR
authors.lastname: Seals
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: King
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Galli
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Isom
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Summers
authors.affiliation: 1 Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Kristi A
authors.initials: KA
authors.lastname: Henderson
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D009722:Nurse Practitioners / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D010360:Patient Transfer; D010820:Physicians / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012424:Rural Population
keywords: Tele-emergency; emergency medicine; rural health care; telemedicine