Emergency Medical Technician Treat-and-leave Patients Receiving Telemedicine Consultation With Emergency Medical Dispatch Physician - a Controlled Before and After Pilot-study
8 december 2015 bijgewerkt door: 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.
Studie Overzicht
Toestand
Voltooid
Conditie
Interventie / Behandeling
Studietype
Ingrijpend
Inschrijving (Werkelijk)
774
Fase
- Niet toepasbaar
Contacten en locaties
In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.
Studie Locaties
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Aarhus N, Denemarken, 8200N
- Prehospital Emergency Medical Services, Aarhus
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Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Kind
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Nee
Geslachten die in aanmerking komen voor studie
Allemaal
Beschrijving
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
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: 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
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Expenses related to EMDC physician vs. savings obtained by avoided admissions
Tijdsspanne: 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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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Percentage of avoided hospital admissions
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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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Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Sponsor
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start
1 september 2014
Primaire voltooiing (Werkelijk)
1 november 2014
Studie voltooiing (Werkelijk)
1 november 2014
Studieregistratiedata
Eerst ingediend
11 juli 2014
Eerst ingediend dat voldeed aan de QC-criteria
26 augustus 2014
Eerst geplaatst (Schatting)
29 augustus 2014
Updates van studierecords
Laatste update geplaatst (Schatting)
9 december 2015
Laatste update ingediend die voldeed aan QC-criteria
8 december 2015
Laatst geverifieerd
1 juli 2014
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- NRA5
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