Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock - Technical Performance

Study Overview
=================
Brief Summary
-----------------
Due to demographic change, the composition of the population in Germany is changing. The consequence of this change is a population that is getting older on average. A key challenge is the appropriate nursing and medical care of older people in senior residences and care facilities. The increasing workload for nursing staff and doctors in the outpatient sector means that timely care for patients, e.g. in the form of GP visits, cannot always be guaranteed in a timely manner. The results are unnecessary or premature hospital admissions as well as ambulance and emergency care interventions, even though in many cases it is not an acute or even life-threatening event. Furthermore, it has been scientifically proven that hospital admissions can increase the risk of patients becoming confused. The aim of this project is to avoid unnecessary hospital admissions and to enable patients to remain in their familiar surroundings as far as this appears medically justifiable. At the same time, the study aims to improve the medical care of nursing home residents through better networking of medical areas, the use of tele-consultations and an early warning system.

Detailed Description
-----------------
The Optimal@NRW project represents a new cross-sectoral approach to the acute care and support of geriatric people in need of care through the implementation of an early warning system and the integration of a telemedical consultation system in 25 nursing homes in the region of Aachen in Germany. The project focuses on restructuring emergency care in nursing homes and improving cooperation between the actors involved (emergency service, emergency department, general practitioners, nursing staff, etc.). Accordingly, a central emergency number of the statutory health insurance funds is to act as a virtual hub for the care of geriatric patients. The concrete approach of the project is that the participating nursing homes first contact the medical call centre (116 117) in case of a medical problem. The call centre is then responsible for an initial medical assessment and decides whether the respective GP can be called in or whether a teleconsultation with the virtual digital desk (i.e. the medical experts from the emergency department of the University Hospital RWTH Aachen) should be carried out. In addition, mobile nursing assistants (NÄPÄ (Z)) will be introduced as part of the project, who can also support the nursing staff and provide services that can be delegated by doctors - especially if the general practitioner is not available at the time. In addition, a standardised early warning system is to be established in the nursing homes and its benefits evaluated. This will enable potentially dangerous changes in the state of health of nursing home residents to be detected earlier. The unique and novel development of the technical concept and the interaction between a central electronic patient record, an early warning system and the telemedical equipment plays a decisive role in the success of the project.

Official Title
-----------------
Optimized Acute Care for Geriatric Patients Using an Intersectoral Telemedical Cooperation Network - Around the Clock - Technical Performance

Conditions
-----------------
Emergencies

Intervention / Treatment
-----------------
* Other: Telemedical support


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Resident of one of the participating nursing homes At least 18 years old Written informed consent Consent of the guardian for residents who are not legally able to give consent Exclusion Criteria: Persons placed in an institution by order of an authority or court Persons who are in a dependent or employment relationship with the investigator

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Stepped-Wedge-Design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Participants in this group are routinely treated. | |
| Active Comparator: Telemedical support<br>Participants in this group are routinely treated with additional telemedical support and the use of the early warning system. | Other: Telemedical support<br>* The nursing homes participating in the project will be equipped with telemedical equipment. This will allow teleconsultations to take place when needed. In addition, an early warning system will be introduced and, within the framework of the teleconsultation, a trained medical assistant can be sent to the care facility if necessary, who can carry out medical activities on site under a physician's delegated instructions. In addition, an electronic patient file will be introduced which can be accessed by the telemedicine physician and the general practitioner.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of non-realized teleconsultations by request | Number of non-realized teleconsultations by request | 6 to 15 months depending on the cluster affiliation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of system crash while running a teleconsultation | Number of system crash while running a teleconsultation | 6 to 15 months depending on the cluster affiliation | 
| Number of incorrect data transmissions within the overall system | Number of incorrect data transmissions within the overall system | 6 to 15 months depending on the cluster affiliation | 
| Duration until the realization of a teleconsultation | Duration until the realization of a teleconsultation | 6 to 15 months depending on the cluster affiliation | 
| Number of causes that lead to system crash | A system crash is defined as a failure of one of the following three components that cannot be recovered within 5 minutes: Audio connection, visual connection, transmission of vital signs. | 6 to 15 months depending on the cluster affiliation | 
| Data transmission rate requirement | Data transmission rate requirement | 6 to 15 months depending on the cluster affiliation | 
| Rate of complications of the early warning system in connection with telemedicine | Rate of complications of the early warning system in connection with telemedicine | 6 to 15 months depending on the cluster affiliation | 
| Performance of the early warning system | - Number of system errors and terminations | 6 to 15 months depending on the cluster affiliation | 
| Performance of the early warning system | - Number of alarms in the early warning system | 6 to 15 months depending on the cluster affiliation | 
| Performance of the early warning system | - Number of false alarms | 6 to 15 months depending on the cluster affiliation | 
| Performance of the early warning system | - time from early warning system alarm to teleconsultation/physician contact | 6 to 15 months depending on the cluster affiliation | 
| Performance of the early warning system | - consequences of an alarming early warning system | 6 to 15 months depending on the cluster affiliation | 
| Performance of the teleconsultation equipment | - Number of complications | 6 to 15 months depending on the cluster affiliation | 
| Performance of the teleconsultation equipment | - Number of disconnection error or failure of components | 6 to 15 months depending on the cluster affiliation | 
| Performance of the teleconsultation equipment | - consultation extent | 6 to 15 months depending on the cluster affiliation | 
| Performance of the teleconsultation equipment | - call duration | 6 to 15 months depending on the cluster affiliation | 
| Performance of the teleconsultation equipment | - devices used | 6 to 15 months depending on the cluster affiliation | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
emergency department, telemedicine, geriatric, early warning score, acute care, nursing home