A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.

Objective-To determine injury patterns and characteristics specific to domestic violence in women who present to the accident and emergency (A&E) department. Design-A retrospective case note review of all female assaults over a one year period. The subjects were women who disclosed that their injuries were due to assaults by either a current or a previous male partner. Identification of markers would be important in alerting clinicians to the possibility of domestic violence, as it is known that many cases are not disclosed,4 5 9 and that attacks tend to be repeated with both increasing frequency and severity.9 [15][16][17] The study examines female assaults, comparing assaults due to domestic violence with a control group of women who were not injured by domestic violence. MethodsOne year of the A&E department medical and nursing case notes were hand searched by one author (RLS) to identify all female assaults. These were classified into two groups: disclosed domestic violence defined as "an assault by a current or previous male partner" and a control group (assault by a non-family member). All assaults by other relatives/family members were excluded. Other groups were excluded if the assailant had not been documented or was unknown. Patient and control groups were compared for injury and referral patterns. There were no directives to doctors during the study year to look for a history of domestic violence.The A&E department is in an urban setting and does not see patients under the age of 13. Statistical analysis was performed with Epi-Info using a X2 test.

Introduction of the National Emergency X-ray Utilization Study guidelines to a UK emergency department did not reduce the number of patients having cervical spine radiographs after neck trauma and had no effect on the pick-up rate for cervical spine injuries.

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Objective-To assess whether the quality of x ray films transmitted via a low cost (low resolution) telemedicine link was satisfactory for clinical diagnosis. Methods-A retrospective study of a set of consecutive accident and emergency (A&E) radiographs. An A&E registrar viewed these directly on a standard x ray viewing box and via a telemedicine link. Results-There were 81 abnormalities out of 234 x ray films. Three abnormalities were missed both on the x ray viewing box and telemedicine link, one of which was significant. There were five additional abnormalities missed on the telemedicine link but detected on the x ray viewing box, ofwhich two were significant. One normal x ray film was interpreted as abnormal on the telemedicine link. There were no false positives on direct viewing. Conclusion-Transference of plain radiographs using a low cost/low resolution telemedicine link by A&E doctors is adequate for clinical interpretation.