Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France.
Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France.
J Am Med Dir Assoc. 2024 Feb;25(2):195-200.e1. doi: 10.1016/j.jamda.2023.09.019. Epub 2023 Oct 27.
To compare the proportion of nursing home residents dispatched to an emergency department (ED) after a call to the emergency medical communication center (EMCC) according to the availability or nonavailability of telemedicine.
This prospective, observational trial was conducted in the EMCC and 74 nursing homes in a French county.
All nursing home residents who needed to contact the EMCC between June 2019 and April 2020 were included in the study. We excluded calls notifying the death of a resident, for completing data from a previous call, and for nursing home staff.
The primary outcome was the proportion of residents dispatched to an ED after their first call to the EMCC. The secondary outcomes were the proportion of second calls, proportion of residents dispatched to an ED after a second call, and proportion of death within 30 days.
We included 3103 calls in the final analysis (355 from equipped nursing homes and 2748 from unequipped nursing homes). The proportion of patients dispatched to an ED after the first call was lower among telemedicine-equipped than among telemedicine-unequipped nursing homes (41% vs 50%; odds ratio, 0.71; 95% CI, 0.56-0.90). The proportion of a second call for the same purpose within 72 hours, proportion of dispatching to an ED at the second call, and proportion of deaths within 30 days were similar between the groups.
The use of telemedicine by nursing home residents requiring a call to the EMCC is associated with a reduction in the number of dispatches to an ED without any increase in the number of 72-hour callbacks or 30-day mortality rates.
比较在向紧急医疗通讯中心（EMCC）致电后，根据是否提供远程医疗，被送往急诊部（ED）的养老院居民的比例。
这是一项在 EMCC 和法国一个县的 74 家养老院进行的前瞻性观察性试验。
所有需要在 2019 年 6 月至 2020 年 4 月期间联系 EMCC 的养老院居民都被纳入研究。我们排除了通知居民死亡的电话、用于完成前一次电话的数据以及养老院工作人员的电话。
主要结果是居民在首次致电 EMCC 后被送往 ED 的比例。次要结果是第二次呼叫的比例、第二次呼叫后被送往 ED 的居民比例以及 30 天内死亡的比例。
我们最终分析了 3103 次呼叫（配备远程医疗的养老院有 355 次，未配备远程医疗的养老院有 2748 次）。与未配备远程医疗的养老院相比，配备远程医疗的养老院中，首次呼叫后送往 ED 的患者比例较低（41% vs 50%；优势比，0.71；95%置信区间，0.56-0.90）。在 72 小时内，为同一目的拨打第二次电话的比例、第二次呼叫时送往 ED 的比例以及 30 天内死亡的比例在两组之间相似。
需要向 EMCC 致电的养老院居民使用远程医疗与送往 ED 的人数减少相关，而在 72 小时内回拨的次数或 30 天死亡率没有增加。
