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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

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ClinicalTrials.gov Identifier: NCT02228317
Recruitment Status : Completed
First Posted : August 29, 2014
Last Update Posted : December 9, 2015
Sponsor:
Collaborators:
Central Denmark Region
Aarhus University Hospital
Information provided by (Responsible Party):
University of Aarhus

Brief Summary:

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.


Condition or disease Intervention/treatment Phase
Acutely Ill Acutely Injured Device: Telemedicine consultation Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 774 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Emergency Medical Technician Treat-and-leave Patients Receiving Telemedicine Consultation With Emergency Medical Dispatch Physician - a Controlled Before and After Pilot-study
Study Start Date : September 2014
Actual Primary Completion Date : November 2014
Actual Study Completion Date : November 2014

Arm Intervention/treatment
Experimental: Telemedicine consultation
EMTs will systematically establish teleconsultation by either telephone or video with the EMDC-physician in all cases of non-critical illness
Device: Telemedicine consultation
Telemedicine consultation done by telephone or video
Other Names:
  • 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.




Primary Outcome Measures :
  1. Expenses related to EMDC physician vs. savings obtained by avoided admissions [ Time Frame: 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.


Secondary Outcome Measures :
  1. Percentage of avoided hospital admissions [ Time Frame: 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

  2. Response time for ambulances [ Time Frame: 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.

  3. Hospital admission within 3 days [ Time Frame: 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.

  4. Time consumption by EMDC physician [ Time Frame: 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

  5. Cause of death [ Time Frame: 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

  6. Patient's evaluation [ Time Frame: 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



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02228317


Locations
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Denmark
Prehospital Emergency Medical Services, Aarhus
Aarhus N, Denmark, 8200N
Sponsors and Collaborators
University of Aarhus
Central Denmark Region
Aarhus University Hospital

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Responsible Party: University of Aarhus
ClinicalTrials.gov Identifier: NCT02228317     History of Changes
Other Study ID Numbers: NRA5
First Posted: August 29, 2014    Key Record Dates
Last Update Posted: December 9, 2015
Last Verified: July 2014
Keywords provided by University of Aarhus:
Emergency Medical Dispatch
Telemedicine
Emergency Medical Services
Pre-hospital
Additional relevant MeSH terms:
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Emergencies
Disease Attributes
Pathologic Processes