Department of Anaesthesiology, RWTH Aachen University, Medical Faculty, Aachen, Nordrhein-Westfalen, Germany
Emergency Department, Kliniken Maria Hilf GmbH, Monchengladbach, Nordrhein-Westfalen, Germany.
BMJ Open. 2021 Mar 24;11(3):e041942. doi: 10.1136/bmjopen-2020-041942.
To review the implementation strategy from a research project towards routine care of a comprehensive mobile physician-staffed prehospital telemedicine system. The objective is to evaluate the implementation process and systemic influences on emergency medical service (EMS) resource utilisation.
Retrospective pre-post implementation study.
Two interdisciplinary projects and the EMS of a German urban region.
Implementation of a full-scale prehospital telemedicine system.
Descriptive evaluation of the implementation strategy. Primary endpoint: ground-based and helicopter-based physician staffed emergency missions before and after implementation.
The first research project revealed positive effects on guideline adherence and patient safety in two simulation studies, with feasibility demonstrated in a clinical study. After technical optimisation, safety and positive effects were demonstrated in a multicentre trial. Routine care in the city of Aachen, Germany was conducted stepwise from April 2014 to March 2015, including modified dispatch criteria. Systemic parameters of all EMS assignments between pre-implementation (April 2013 to March 2014) and post implementation (April 2015 to March 2016): on-scene EMS physician operations decreased from 7882/25 187 missions (31.3%) to 6360/26 462 (24.0%), p<0.0001. The need for neighbouring physician-staffed units dropped from 234/25 187 (0.93%) to 119/26 462 (0.45%), p<0.0001, and the need for helicopter EMS from 198/25 187 (0.79%) to 100/26 462 (0.38%), p<0.0001. In the post implementation period 2347 telemedical interventions were conducted, with 26 462 emergency missions (8.87%).
A stepwise implementation strategy allowed transfer from the project phase to routine care. We detected a reduced need for conventional on-scene physician care by ground-based and helicopter-based EMS, but cannot exclude unrecognised confounders, including modified dispatch criteria and possible learning effects. This creates the potential for increased availability of EMS physicians for life-threatening emergencies by shifting physician interventions from conventional to telemedical care.
NCT04127565.
回顾从研究项目向全面移动医师配备的院前远程医疗系统常规护理实施策略。目的是评估实施过程和对紧急医疗服务（EMS）资源利用的系统影响。
回顾性实施前后研究。
德国一个城市地区的两个跨学科项目和 EMS。
全面实施院前远程医疗系统。
实施策略的描述性评估。主要终点：实施前后地面和直升机配备医师的紧急任务。
第一个研究项目在两项模拟研究中显示出对指南遵循和患者安全的积极影响，并在临床研究中证明了可行性。经过技术优化，在一项多中心试验中证明了安全性和积极效果。德国亚琛市的常规护理于 2014 年 4 月至 2015 年 3 月分阶段进行，包括修改后的调度标准。实施前（2013 年 4 月至 2014 年 3 月）和实施后（2015 年 4 月至 2016 年 3 月）所有 EMS 任务的系统参数：现场 EMS 医师操作从 7882/25187 次（31.3%）减少到 6360/26462（24.0%），p<0.0001。对附近配备医师的单位的需求从 234/25187（0.93%）降至 119/26462（0.45%），p<0.0001，对直升机 EMS 的需求从 198/25187（0.79%）降至 100/26462（0.38%），p<0.0001。在实施后期间进行了 2347 次远程医疗干预，有 26462 次紧急任务（8.87%）。
分阶段实施策略允许从项目阶段转移到常规护理。我们发现地面和直升机基础 EMS 对常规现场医师护理的需求减少，但不能排除修改后的调度标准和可能的学习效应等未被识别的混杂因素。这通过将医师干预从常规护理转移到远程医疗护理，为危及生命的紧急情况增加了 EMS 医师的可用性。
NCT04127565。
