TelEmergency: Distance emergency care using nurse practitioners

Abstract

Study objectives: Delivering quality emergency care in rural areas is a difficult problem, largely because of physician allocation and economics. We test a telemedicine model using nurse practitioners and physician supervisors who are emergency specialists to address this concern. Methods: Thirty nurse practitioners enrolled, and 26 completed the training program. Training consisted of 7 10-hour didactic sessions and between 100 and 200 clinical hours functioning under direct supervision in a teaching hospital (emergency department [ED], operating room, pediatric ICU). Nurse practitioners were not approved to work in rural hospitals unless approved by all faculty supervisors. A nurse practitioner was contracted with a rural hospital and treated patients by a telemedicine link with the physician located at the teaching hospital. Currently, 21 of these nurse practitioners are contracted with a rural hospital. Results: The system began operation in October 2003 and now involves 7 rural hospital EDs. During the first 6 months (October 1, 2003, to March 31, 2004), a total of 5,864 patients were treated; 4,446 were treated and released, 542 admitted, 496 transferred to another institution, and 40 left before being treated. No patient was transferred for inability to deliver care or formulate a diagnosis; all transfers were for higher level of care (operating room, ICU, burn center). Hospital administrators have expressed unanimous approval. Physicians approved of the system but had occasional difficulty viewing radiographs initially (resolved with digital transmission). In response to a survey (n=242), 97.48% of patients were comfortable or very comfortable with the system, 95.4% had no difficulty with seeing or hearing the physician, 98.34% said care was as good as care from a physician alone, 96.28% stated care was as good as from a physician in person, 96.69% rated the overall care as good or excellent, 91.74% said they would use the system again, and 84.58% expressed no concern about privacy. Conclusion: A nurse practitioner–physician telemedicine model to deliver rural emergency care would appear to be a valid option and would be economically feasible. More experience is necessary.