Emergency Medical Technician Treat-and-leave Patients Receiving Telemedicine Consultation With Emergency Medical Dispatch Physician - a Controlled Before and After Pilot-study
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.
연구 개요
연구 유형
등록 (실제)
단계
- 해당 없음
연락처 및 위치
연구 장소
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Aarhus N, 덴마크, 8200N
- Prehospital Emergency Medical Services, Aarhus
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참여기준
자격 기준
공부할 수 있는 나이
- 어린이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
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
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: Telemedicine consultation
EMTs will systematically establish teleconsultation by either telephone or video with the EMDC-physician in all cases of non-critical illness
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Telemedicine consultation done by telephone or video
다른 이름들:
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Expenses related to EMDC physician vs. savings obtained by avoided admissions
기간: Will be assessed at the time of consultation, expected to be presented within 36 months after assessment
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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.
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Will be assessed at the time of consultation, expected to be presented within 36 months after assessment
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Percentage of avoided hospital admissions
기간: Treated-and-left or not will be assessed at the time of consultation, expected to be presented within 36 months of assessment
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Is the difference in percentage of treat-and-leave patients in the intervention period and historical control period
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Treated-and-left or not will be assessed at the time of consultation, expected to be presented within 36 months of assessment
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Response time for ambulances
기간: Is assessed at the time the EMT registers arrival on site, expected to be presented within 36 months of assessment
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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.
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Is assessed at the time the EMT registers arrival on site, expected to be presented within 36 months of assessment
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Hospital admission within 3 days
기간: Will be assessed at the 72 hours after consultation, expected to be presented within 36 months of assessment
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Percentage of patients where initial hospital admission is avoided, but are admitted to hospital within 72 hours after primary contact.
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Will be assessed at the 72 hours after consultation, expected to be presented within 36 months of assessment
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Time consumption by EMDC physician
기간: Will be assessed within 1 minute after end of consultation, expected to be presented within 36 months after assessment
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Registered as the time from receiving phone call or establishing video contact to connection is discontinued
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Will be assessed within 1 minute after end of consultation, expected to be presented within 36 months after assessment
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Cause of death
기간: 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
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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
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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
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Patient's evaluation
기간: Will be assessed within 72 hours after end of consultation, expected to be presented within 36 months after assessment
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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
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Will be assessed within 72 hours after end of consultation, expected to be presented within 36 months after assessment
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공동 작업자 및 조사자
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
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