TelEmergency: distance emergency care in rural emergency departments using nurse practitioners.

388 roviding quality emergency care in rural hospitals P low patient volumes can be cost prohibitive. Additionally, recruiting and retaining physicians in these rural areas is difficult. Mississippi, a mostly rural state, shares this nationwide problem: There simply are not enough Board Certified Emergency Medicine physicians to serve rural hospitals in the state. As a result, emergency departments have been staffed with physicians and/or nurse practitioners (NPs) who are not trained in emergency medicine, often are temporary employees, and are not invested in the community. Nevertheless, rural hospitals are burdened financially when they attempt to retain these contract providers. Patients, hospitals, and communities in Mississippi were dissatisfied with this staffing method, its cost, and the level of care provided. A telemedicine system that uses NPs and the emergency department at the University of Mississippi Medical Center (UMMC) has become a viable alternative and has provided effective, appropriate, emergency care to these rural hospitals. The program presented in this article, TelEmergency, combines specially educated family nurse practitioners (FNPs) via a telemedicine link with the emergency medicine (EM) physicians at UMMC. It provides increased access and improved quality of care to hospital emergency departments across Mississippi. An analysis of the first 2 years of operation shows positive patient outcomes, costeffectiveness, and user satisfaction.