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Emergency Medical Technician Treat-and-leave Patients Receiving Telemedicine Consultation With Emergency Medical Dispatch Physician - a Controlled Before and After Pilot-study

8. prosince 2015 aktualizováno: University of Aarhus

A large part of acutely ill patient's access to the health care system starts by calling the emergency number 1-1-2 and thereby getting in touch with the emergency medical dispatch center (EMDC). In most cases an ambulance is dispatched and the patient is brought to the hospital. These patients are not referred by a physician (eg. a GP) and represent an unselected subpopulation of the acutely ill patients. At present, all non-critically ill patients not evaluated by a pre-hospital physician are normally be transported to hospital as category 2 (without activated emergency lightning and sirens).A part of this patient population, however, is not critically ill and a proportion of these may not need hospital admittance . Emergency medical technicians (EM) are not allowed to treat - and- leave patients without a physician's involvement. If the EMT had 24/7 online access to medical control i.e. in form of a physician present in the EMDC , the number of patients transported to hospital for assessment may be reduced as well as response times for patients actually needing ambulance transportation. This could potentially reduce the workload on the whole healthcare system involved in the management of these patients - thereby potentially reducing costs.

The objective of this study is to evaluate if a systematic telemedical assessment by an EMDC-physician of all patients who receive an ambulance but are not critically ill and would have a category 2 transport to hospital can reduce the number of the patients that are transported to hospital and save costs and time.

Přehled studie

Postavení

Dokončeno

Podmínky

Intervence / Léčba

Typ studie

Intervenční

Zápis (Aktuální)

774

Fáze

  • Nelze použít

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní místa

  • Dánsko
      • Aarhus N, Dánsko, 8200N
        • Prehospital Emergency Medical Services, Aarhus

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

  • Dítě
  • Dospělý
  • Starší dospělý

Přijímá zdravé dobrovolníky

Ne

Pohlaví způsobilá ke studiu

Všechno

Popis

Inclusion Criteria:

  • Patients receiving an emergency ambulance after calling the EMDC Patients who are going to be admitted to a Hospital in the Central Denmark Region.
  • Patients who are going to be transported as category 2 patients (non-critical illness, not requiring transport with activated lightning and sirens.

Exclusion Criteria:

  • Critically ill patients (Patients who are going to be transported as category 1 patients (critical-illness, requiring immediate transport with activated sirens and warning lights )
  • Patients who are not supposed to be admitted to a hospital in the Central Denmark Region

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: N/A
  • Intervenční model: Přiřazení jedné skupiny
  • Maskování: Žádné (otevřený štítek)

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Experimentální: Telemedicine consultation
EMTs will systematically establish teleconsultation by either telephone or video with the EMDC-physician in all cases of non-critical illness
Přístroj: Telemedicine consultation
Telemedicine consultation done by telephone or video
Ostatní jména:
  • For video consultation iPAD AIR 4G/3G 16 GB will be used.
  • LifeSize ClearSea solution will be used for videoconferencing.
  • 4G/3G mobile network.
  • For telephone consultation Nokia C2-01 GSM telephone will be used.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Expenses related to EMDC physician vs. savings obtained by avoided admissions
Časové okno: Will be assessed at the time of consultation, expected to be presented within 36 months after assessment
Cost of 24 hour EMDC physician vs. savings obtained by avoided admissions. Calculations of average transport related costs will be provided by the Prehospital Emergency Medical Services Aarhus and average cost of hospitalization for a patient hospitalized 24 hours or less at the emergency dept. will be provided by the Regional Hospital Horsens. The percentage of treat-and-leave patients in the intervention period will be compared to a historical control group represented by the average percentage of treat-and-leave patients for the previous 12 months (August 2013 to August 2014). The savings obtained by avoided admissions will be calculated by multiplying the difference in the proportion of treat and leave patients with the number of patients the previous 12 months who are receiving an ambulance after dialing 112. The EMDC physician related costs will be calculated from the present table of salary for specialist physicians in Denmark.
Will be assessed at the time of consultation, expected to be presented within 36 months after assessment

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Percentage of avoided hospital admissions
Časové okno: Treated-and-left or not will be assessed at the time of consultation, expected to be presented within 36 months of assessment
Is the difference in percentage of treat-and-leave patients in the intervention period and historical control period
Treated-and-left or not will be assessed at the time of consultation, expected to be presented within 36 months of assessment
Response time for ambulances
Časové okno: Is assessed at the time the EMT registers arrival on site, expected to be presented within 36 months of assessment
Defined as the average response time for ambulances dispatched by EMDC. The average response time is calculated as the time where the emergency medical dispatcher gets an assignment (registered manually by the dispatcher) to the arrival of the ambulance at scene (registered manually by the EMS technician). This definition of response time is predefined politically and is the gold standard for this measurement across dispatch centers in Denmark.
Is assessed at the time the EMT registers arrival on site, expected to be presented within 36 months of assessment
Hospital admission within 3 days
Časové okno: Will be assessed at the 72 hours after consultation, expected to be presented within 36 months of assessment
Percentage of patients where initial hospital admission is avoided, but are admitted to hospital within 72 hours after primary contact.
Will be assessed at the 72 hours after consultation, expected to be presented within 36 months of assessment
Time consumption by EMDC physician
Časové okno: Will be assessed within 1 minute after end of consultation, expected to be presented within 36 months after assessment
Registered as the time from receiving phone call or establishing video contact to connection is discontinued
Will be assessed within 1 minute after end of consultation, expected to be presented within 36 months after assessment
Cause of death
Časové okno: Will be assessed as soon as possible after the occurence of death, normally within 24 hours, expected to be presented within 36 months of assessment
Audit on all patients dying within 30 days of primary contact. Patient's electronic medical record will be assessed by two independent consultant physicians with no relation to EMDC in order to evaluate if death of a treat-and-leave patient can be attributed to treat-and-leave
Will be assessed as soon as possible after the occurence of death, normally within 24 hours, expected to be presented within 36 months of assessment
Patient's evaluation
Časové okno: Will be assessed within 72 hours after end of consultation, expected to be presented within 36 months after assessment
Patient's evaluation of prehospital care. Telephone survey of all included patients in the intervention period will be conducted within 72 hours after teleconsultation with EMDC-physician
Will be assessed within 72 hours after end of consultation, expected to be presented within 36 months after assessment

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

University of Aarhus

Spolupracovníci

Aarhus University Hospital
Central Denmark Region

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia

1. září 2014

Primární dokončení (Aktuální)

1. listopadu 2014

Dokončení studie (Aktuální)

1. listopadu 2014

Termíny zápisu do studia

První předloženo

11. července 2014

První předloženo, které splnilo kritéria kontroly kvality

26. srpna 2014

První zveřejněno (Odhad)

29. srpna 2014

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Odhad)

9. prosince 2015

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

8. prosince 2015

Naposledy ověřeno

1. července 2014

Více informací

Termíny související s touto studií

Klíčová slova

Další relevantní podmínky MeSH

Další identifikační čísla studie

  • NRA5

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