THE TENTH ANNIVERSARY OF TELEMERGENCY Richard L. Summers, MD
Professor and Chairman, Department of Emergency Medicine, University of Mississippi Medical Center
Kristi Henderson, DNP, NP-BC, FAEN
Director of Telehealth, University of Mississippi Medical Center
Kristen C. Isom, Stroke & STEMI
Coordinator, Telemedicine Liaison, Anderson Regional Hospital
Robert L. Galli, MD
Professor and Director of TelEmergency, Department of Emergency Medicine, University of Mississippi Medical Center
October 2013 marks the 10-year anniversary of the TelEmergency program at the University of Mississippi Medical Center.1 The program was initially started with the assistance of private foundation funding I had acquired, but the concept and most of the original organization of the system was the work of Robert L. Galli, MD and Kristi Henderson, DNP, NP-BC, with technical expertise from Greg Hall. The program was born from a consensus within our group that there was a serious need to improve emergency care in our state. At that time we frequently received badly managed critical patients in transfer to our emergency department, particularly from critical access hospitals in small communities where there were no physicians with emergency expertise available. Often these EDs were serviced by local physicians who were also covering their clinics or by nurse practitioners with a family medicine orientation. The prospect of retaining true emergency physicians to cover these departments was financially and logistically unfeasible. On the other hand, closure of these hospitals would leave large gaps in the availability of medical care for an already underserved population. In many of these communities it might require hours of travel to find the first available hospital for emergency services. However, poor emergency medical care is often worse than no care at all. Many other states are facing similar issues. Recent workforce studies for emergency medicine indicate that residency–trained/ board-certified emergency physicians will not be able to satisfy the workforce demands for many years to come.2 This problem is even more severe in rural areas where the percentages of true emergency physicians typically comprise only a small fraction of the needed workforce, with most of the emergency departments being serviced by family medicine physicians and nurse practitioners.3 A strategy which uses a telemedicine connection to provide some emergency medicine expertise to these struggling medical communities is one possible solution. Our TelEmergency system operates like an ED on a 24/7 basis, with a board certified emergency physician in our telemedicine console room ready to answer all calls. This room is contiguous with our own ED, which allows for the utilization of many additional resources if needed. Emergency consultations are available for any patient that arrives at one of our distance sites, as determined by the provider at that location. We encourage engagement with the service for any patients of ESI acuity of 3 or greater. Telemedicine equipment mounted on a mobile cart allows for two-way audio and visual communication between the patient or distant provider and the physician at our console. The telemedicine audiovisual equipment uses a secure T-1 network as
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its framework for communication. There are also mechanisms in place for the electronic downloading and surveillance of images, laboratory data, and electrocardiograms from the distant site. With this system, we have assisted in running codes, delivering babies, and many other forms of acute care management in real time. If necessary, we can easily launch the helicopter from the telemedicine room for quick transports, and in the past have sent a doctor to the distant site in a time of disaster. We also have some telemedicine sites on oil rigs in the Gulf of Mexico. Preventing the unnecessary transport of these patients can save thousands of dollars. The current TelEmergency program now serves 17 rural hospital emergency departments in Mississippi, at multiple geographically distant sites, through interactions with nurse practitioners, family medicine physicians, and emergency physicians. There are another nine hospitals slated to join the program over the next Continued on Page 15