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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 dicembre 2015 aggiornato da: 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.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Tipo di studio

Interventistico

Iscrizione (Effettivo)

774

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

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

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Bambino
  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

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

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: N / A
  • Modello interventistico: Assegnazione di gruppo singolo
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Telemedicine consultation
EMTs will systematically establish teleconsultation by either telephone or video with the EMDC-physician in all cases of non-critical illness
Dispositivo: Telemedicine consultation
Telemedicine consultation done by telephone or video
Altri nomi:
  • 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.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Expenses related to EMDC physician vs. savings obtained by avoided admissions
Lasso di tempo: 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

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Percentage of avoided hospital admissions
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

University of Aarhus

Collaboratori

Aarhus University Hospital
Central Denmark Region

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio

1 settembre 2014

Completamento primario (Effettivo)

1 novembre 2014

Completamento dello studio (Effettivo)

1 novembre 2014

Date di iscrizione allo studio

Primo inviato

11 luglio 2014

Primo inviato che soddisfa i criteri di controllo qualità

26 agosto 2014

Primo Inserito (Stima)

29 agosto 2014

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Stima)

9 dicembre 2015

Ultimo aggiornamento inviato che soddisfa i criteri QC

8 dicembre 2015

Ultimo verificato

1 luglio 2014

Maggiori informazioni

Termini relativi a questo studio

Parole chiave

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • NRA5

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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