In 1996 we studied patients attending a minor accident and treatment service in London, some of whom were the subjects of teleconsultations with a main hospital emergency department. In the subsequent four years, 56,139 patients were seen at the minor accident and treatment service unit. Teleconsultations were performed in 2032 cases (3.6%). Most of the teleconsultations (58%) concerned patients with fractures. The main reason for teleconsultation was to review and discuss radiographs (46%). In comparison with the 1996 study, both the emergency nurse practitioners and the consultant had improved the accuracy of their teleradiology diagnosis, although the difference was not significant. Most of the telemedicine patients (90%) did not need a transfer to the main department. Thus telemedicine allowed local decision making in the majority of cases. In the 1996 survey, 75% of patients were sent to their general practitioner or to the main hospital department; in the present survey, this proportion had halved, to 38%. The present study showed that teleconsultations are an effective way of preventing patients being transferred unnecessarily from a minor accident and treatment service to the main hospital accident and emergency department.
