The Impact of Telemedicine, Using the Caller's Mobile Phone Camera, on the Quality of Care Provided to Adult Patients Contacting the 15 Centre for Acute Dyspnea (TELEDYS)

Dyspnea is the subjective sensation of difficult or uncomfortable breathing. It accounts for approximately 10% of emergency department visits and 8% of calls to Emergency Medical Communication Centers. Nearly half of patients presenting with dyspnea require hospital admission, 15% require ventilatory support, and approximately 5% die. Early recognition of signs of respiratory severity is therefore essential to accurately assess clinical urgency, guide diagnostic evaluation, and inform appropriate management decisions.

In France, patients are encouraged to contact an Emergency Medical Communication Centers before presenting to an emergency department. Calls are managed by an emergency physician responsible for medical regulation, who performs a remote clinical assessment and determines the most appropriate level of care. Depending on the clinical evaluation, the physician may provide medical advice, refer the patient to an emergency department, dispatch emergency medical services, or send a physician-staffed mobile intensive care unit for life-threatening emergencies.

The remote assessment of patients presenting with dyspnea is particularly challenging. The inability to directly observe or examine the patient, combined with the caller's difficulty in accurately describing the clinical situation, may impair the recognition of disease severity and result in inappropriate triage decisions, including under-triage and over-triage :

Under-triage, characterized by failure to dispatch appropriate emergency resources or to refer the patient to an emergency department when indicated, may delay treatment and increase the risk of adverse outcomes, including mortality.

Conversely, over-triage, defined as unnecessary referral to primary care or emergency departments or inappropriate dispatch of emergency resources, contributes to emergency department overcrowding, inefficient use of prehospital resources, and increased healthcare costs.

In a previous study, we demonstrated that video-assisted medical triage improved emergency physicians' ability to assess the severity of patients presenting with acute dyspnea. This telemedicine tool enables real-time transmission of a live video stream from the caller's smartphone camera to the emergency physician through a secure digital platform, providing direct visualization of the patient's clinical condition. By enhancing remote clinical assessment, video-assisted triage has the potential to reduce both under-triage and over-triage.

In the present stepped-wedge cluster randomized trial, we hypothesized that incorporating real-time video support into the medical regulation of adult patients contacting an Emergency Medical Communication Centers for acute dyspnea would improve the quality of medical decision-making compared with standard telephone triage alone.

Study Overview

• Status: Not yet recruiting
• Conditions: Dyspnea
• Intervention / Treatment: Other: Addition of telemedine to standard medical dispatching process

• Study Type: Interventional
• Enrollment (Estimated): 778
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nicolas MARJANOVIC; Phone Number: +33549441873; Email: nicolas.marjanovic@chu-poitiers.fr
• Study Contact Backup: Name: Sabrina SEGUIN; Phone Number: +33549443229; Email: sabrina.seguin@chu-poitiers.fr

Study Locations

• France
  • Poitiers, France, 86021
    • University Hospital of Poitiers
    • Contact: Nicolas MARJANOVIC; Phone Number: +33549441873; Email: nicolas.marjanovic@chu-poitiers.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 18 or over
• Contacting the Emergency Medical Communication Center regarding acute dyspnea, respiratory distress or shortness of breath, as the main reason for the call, regardless of the underlying cause
• The patient or a bystander must have a mobile phone equipped with a camera and capable of making video calls
• Emergency inclusion authorized by the emergency physician responsible for medical regulation in accordance with the emergency consent procedure applicable at the time of the call

Exclusion Criteria:

• An immediate life-threatening emergency justifying the dispatch of an emergency response team on an automatic basis in accordance with local protocols
• Patient at the end of life or where a decision to limit treatment is known at the time of the call.
• Refusal to use telemedicine
• Lack of a telephone network enabling video consultation.
• Patient already included in the study.
• Individuals requiring enhanced protection, namely minors, pregnant or breastfeeding women, persons deprived of their liberty by a judicial or administrative decision, and adults under legal guardianship known at the time of the call

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Standard medical dispatching process (Control group)
Experimental: Addition of telemedecine to standard medical dispatching process (Experimental group)	Other: Addition of telemedine to standard medical dispatching process; Patients included during the intervention phase will undergo video-assisted medical triage. Video-assisted triage will be performed using a secure web-based telemedicine hosted on a certified health data server. The emergency physician responsible for medical regulation will send a secure web link via SMS to the caller's smartphone or, when appropriate, to the smartphone of a relative or bystander. Once the link has been activated, a live video stream captured by the smartphone camera will be securely transmitted in real time to the physician's workstation at the Emergency Medical Communication Center, enabling direct visualization of the patient's clinical condition during the remote assessment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine whether the use of video-assisted medical triage improves the quality of medical decision-making during the regulation of adult patients contacting Emergency Medical Communication Center with acute dyspnea	To determine whether the use of video-assisted medical triage, based on real-time transmission from the caller's smartphone camera, improves the quality of medical decision-making during the regulation of adult patients contacting Emergency Medical Communication Center with acute dyspnea as their primary complaint by reducing the proportion of under-triage and over-triage. Definitions: Under-triage is defined as the assignment of a level of response that is insufficient for the patient's actual clinical needs. Over-triage is defined as the assignment of a level of response that exceeds the patient's actual clinical needs.	28 days

Secondary Outcome Measures

Outcome Measure	Time Frame
To compare patients managed with and without video-assisted medical triage with respect to the proportion of patients experiencing under-triage	28 days
To compare patients managed with and without video-assisted medical triage with respect to the proportion of patients experiencing over-triage	28 days
To compare patients managed with and without video-assisted medical triage with respect to the proportion of patients requiring advanced respiratory support (defined as any oxygenation or ventilatory support beyond conventional oxygen therapy)	3 hours, 24 hours, 28 days
To compare patients managed with and without video-assisted medical triage with respect to the proportion of patients admitted to an intensive care unit	24 hours
To compare patients managed with and without video-assisted medical triage with respect to the proportion of patients experiencing cardiac arrest	3 hours, 24 hours, 28 days
To compare patients managed with and without video-assisted medical triage with respect to all-cause mortality	3 hours, 24 hours, 28 days
To compare patients managed with and without video-assisted medical triage with respect to the total duration of the medical regulation process	Immediately after the procedure
Medical economic impact: cost-effectiveness study (difference in costs divided by the difference in effectiveness: cost/serious complication avoided)	28 days

Collaborators and Investigators

• Sponsor: Poitiers University Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: July 13, 2026
• First Submitted That Met QC Criteria: July 21, 2026
• First Posted (Actual): July 24, 2026

Study Record Updates

• Last Update Posted (Actual): July 24, 2026
• Last Update Submitted That Met QC Criteria: July 21, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Triage; Telemedecine; Dispatch
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Dyspnea
• Other Study ID Numbers: 2026-A00879-42

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No