Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
Global Medical Response, Inc., Greenwood Village, Colorado.
Prehosp Emerg Care. 2024;28(5):706-711. doi: 10.1080/10903127.2023.2266023. Epub 2023 Oct 27.
Emergency medical services (EMS) facilitated telemedicine encounters have been proposed as a strategy to reduce transports to hospitals for patients who access the 9-1-1 system. It is unclear which patient impressions are most likely able to be treated in place. It is also unknown if the increased time spent facilitating the telemedicine encounter is offset by the time saved from reducing the need for transport. The objective of this study was to determine the association between the impressions of EMS clinicians of the patients' primary problems and transport avoidance, and to describe the effects of telemedicine encounters on prehospital intervals.
This was a retrospective review of EMS records from two commercial EMS agencies in New York and Tennessee. For each EMS call where a telemedicine encounter occurred, a matched pair was identified. Clinicians' impressions were mapped to the corresponding category in the International Classification of Primary Care, 2nd edition (ICPC-2). Incidence and rates of transport avoidance for each category were determined. Prehospital interval was calculated as the difference between the time of ambulance dispatch and back-in-service time.
Of the 463 prehospital telemedicine evaluations performed from March 2021 to April 2022, 312 (67%) avoided transports to the hospital. Respiratory calls were most likely to result in transport avoidance ( = 0.018); no other categories had statistically significant transport rates. Four hundred sixty-one (99.6%) had matched pairs identified and were included in the analysis. When compared to the matched pair, telemedicine without transport was associated with a prehospital interval reduction in 68% of the cases with a median reduction of 16 min; this is significantly higher than telemedicine with transport when compared to the matched pair with a median interval increase in 27 min. Regardless of transport status, the prehospital interval was a median of 4 min shorter for telemedicine encounters than non-telemedicine encounters ( = 0.08).
In this study, most telemedicine evaluations resulted in ED transport avoidance, particularly for respiratory issues. Telemedicine interventions were associated with a median four-minute decrease in prehospital interval per call. Future research should investigate the long-term effects of telemedicine on patient outcomes.
为了减少通过 9-1-1 系统接入的患者向医院转运，人们提出了由急救医疗服务（EMS）协助进行远程医疗会诊的策略。目前尚不清楚哪些患者的印象最有可能就地治疗。也不知道协助远程医疗会诊所花费的时间是否会因减少转运需求而节省时间。本研究的目的是确定 EMS 临床医生对患者主要问题和避免转运的印象与避免转运之间的关联，并描述远程医疗会诊对院前间隔时间的影响。
这是对纽约和田纳西州的两家商业 EMS 机构的 EMS 记录进行的回顾性研究。对于每一次发生远程医疗会诊的 EMS 呼叫，都确定了一对匹配的病例。临床医生的印象被映射到国际初级保健分类 2 版（ICPC-2）的相应类别中。确定了每个类别的转运回避发生率和转运回避率。院前间隔时间的计算方法为救护车派遣时间与恢复服务时间之间的差值。
在 2021 年 3 月至 2022 年 4 月期间进行的 463 次院前远程医疗评估中，有 312 次（67%）避免了转运至医院。呼吸类呼叫最有可能避免转运（ = 0.018）；没有其他类别具有统计学显著的转运率。确定了 461 对（99.6%）匹配的病例并纳入分析。与匹配病例相比，无转运的远程医疗与 68%的病例的院前间隔时间缩短相关，中位数缩短 16 分钟；与匹配病例相比，转运的远程医疗间隔中位数增加 27 分钟，这明显更高。无论转运状态如何，与非远程医疗相比，远程医疗的院前间隔中位数缩短了 4 分钟（ = 0.08）。
在这项研究中，大多数远程医疗评估结果导致 ED 转运回避，特别是针对呼吸问题。远程医疗干预与每次呼叫的院前间隔中位数缩短 4 分钟相关。未来的研究应调查远程医疗对患者结局的长期影响。
