Kristi Henderson

The impact of the TelEmergency program on rural emergency care: An implementation study

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.

Prevalence of Intubation Rescue by Air Medical Personnel During Transfers From Rural Emergency Departments

OBJECTIVE Non-emergency-trained providers in rural emergency departments (ED) often lack the skills required for emergency resuscitations and rely on air medical transport teams to provide the initial airway stabilization of these patients. In this study, we determined the prevalence with which endotracheal intubations are required of air medical personnel upon arrival to rural EDs including intubations that were first attempted by the local provider. METHODS A retrospective database review was conducted of all air medical transfers from rural hospitals for a 28-month period. Those patients requiring an airway were categorized according to which provider initiated the intubation procedure. The prevalence of intubations performed by air medical and local providers was recorded as the percent of the total number of intubations. RESULTS There were a total of 217 patients from 11 rural EDs requiring airway support. Air medical personnel were responsible for 85% of the intubations. Alternative airway support was necessary in 5% of the patients after unsuccessful intubation attempts. The failed intubations tended to be slightly older and female. CONCLUSION Our study suggests that the vast majority of the intubations for patients requiring a helicopter evacuation from these rural settings are performed by the air medical personnel.

Nursing summit: Improving transitions in care through collaboration and technology

C are coordination and interoperability are current “buzz” words in healthcare. Nurses are key players in care coordination, particularly when transitioning patients from one area to another, including the community. Current care is fragmented or siloed, resulting in preventable medical morbidity, readmissions, declining functional status, and dependence on others for care. This is very costly, with an estimated cost of failures in care coordination of

TelEmergency: A Novel System for Delivering Emergency Care to Rural Hospitals

42 billion to

TelEmergency: Distance Emergency Care in Rural Emergency Departments Using Nurse Practitioners

45 billion in 2011 alone. Technology exists to support an integrated approach to care but is often not utilized. Further, electronic healthcare records (EHRs) across settings lack interoperability, and many community providers do not have EHRs. Few opportunities exist for providers, payers, and technology to interact to address these complex issues together. Seven RobertWood Johnson Executive Nurse Fellows (2013 Cohort) (Team IMPaCT) organized a care coordination summit as part of their project. Team IMPaCT consisted of nursing leaders from various healthcare arenas, including school health, acute care, public health, and academic education. A central goal of the summit was to improve understanding and communication between hospital and community. Members of Team IMPaCT conducted interviews and focus groups with patients, families, and healthcare professionals to gain insider knowledge on transitions in care (see Table 1 for common themes of the interviews and focus groups). This was followed by a national summit engaging providers, payers, technology, and the community using liberating structures methodology to generate actionable prototypes and projects to facilitate improved transitions in care.