How do teleconsultations for remote trauma management change over a periodof time?

We obtained follow-up information about the new patients seen at a minor ac cident and treatment service (MATS) staffed by emergency nurse practitioner s (ENPs). A previous study, of 150 teleconsultations in a six-month period starting in April 1996, was used for comparison. In the present series, 150 teleconsultations occurring in a four-month period starting in April 1999 were studied; the patients constituted 5.6% of the 2658 new attenders or 3. 8% of the 3936 total attenders. In comparison with the study three years be fore, falling teleconsultation rates were partly offset by increasing numbe rs of attenders and an extension of the ENPs' roles and skills. Teleconsult ation rates rose when the number of consultant-run clinics was curtailed an d ENP-run clinics replaced some of them. Eligibility to request and report more radiographs reduced the need for teleconsultations, and subsequently t eleconsultations for help with interpretation of radiographs fell as the EN Ps became more experienced. Specialty residents trusted ENP judgement and a ccepted telephoned direct admission of cases to their wards. Fewer telecons ultations were required for soft-tissue injuries. Telemedicine is an excell ent educational tool.