Implementation Strategy and Systemic Effects of Routine Telemedical Care in Prehospital Emergency Medicine

Study Overview
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Brief Summary
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In two research projects a comprehensive prehospital telemedicine system was developed and general feasibility as well as impact on guideline adherence were evaluated. These results allowed stepwise implementation into medical routine care. All steps and milestones from the research idea to implementation were analyzed and evaluated descriptively in this study. Using a pre-post intervention analysis the systemic effects of the implementation on change in emergency medical resource utilization were analyzed.

Detailed Description
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In two interdisciplinary research projects a comprehensive prehospital telemedicine system was developed and general feasibility as well as impact on guideline adherence were evaluated. Feasibility and general safety were demonstrated. These results allowed stepwise implementation into medical routine care during a one year phase. During implementation positive effects on guideline adherence were found. Despite positive results there are many barriers that prevent implementation of research projects into routine medical care. Therefore, the current study evaluated and interpreted all steps and milestones from the research idea to implementation and evaluated them descriptively. Using a pre-post intervention analysis the systemic effects of the implementation on change in emergency medical resource utilization were analyzed. Resource utilization of physician staffed emergency medical service units was compared between a pre-implementation period (12 months, April 2013 - March 2014) and a post-implementation period (12 months, April 2015 - March 2016). During the pre-implementation period only standard care was available. Inclusion criteria: All emergency medical service (EMS) missions in both periods. Data sources: Electronic health records of the EMS missions (data pseudonymity) and database of the regional EMS dispatch center.

Official Title
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Implementation Strategy From Research to Routine Care of a Comprehensive Prehospital Telemedicine System and Pre-post Analysis of Systemic Effects

Conditions
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Telemedicine Usage, Teleconsultation Usage, Emergency Medical Service Missions

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients treated by emergency medical service during the pre- and post-implementation period. Post-implementation period: Patients had to give verbal consent prior to teleconsultation. Exclusion Criteria: Pre-implementation period: none Post-implementation period: Patients who refused teleconsultation.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-implementation period<br>All emergency medical service missions (EMS) in the city of Aachen (Germany) from April 2013 to March 2014. Analysis of all ambulance calls and fraction of calls with support by an physician-staffed EMS unit, help of neighboring EMS units and helicopter emergency medical service units. | |
| Post-implementation period<br>All emergency medical service missions (EMS) in the city of Aachen (Germany) from April 2015 to March 2016. Analysis of all ambulance calls and fraction of calls with support by an physician-staffed EMS unit, help of neighboring EMS units and helicopter emergency medical service units. Additionally analysis of all ambulance calls with telemedical support. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in usage of physician staffed EMS units | Change in usage of physician staffed EMS units (ground based and helicopter based). Comparison between the pre- and post-implementation period. | Comparison between 1 year pre-implementation and 1 year post-implementation period. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Usage of telemedical support in the post-implementation period | Number of ambulance calls using telemedical support | Through study completion in the post-implementation period (1 year) | 
| Provided medications during teleconsultation | Number of delegated medications including opioids in the post-implementation phase | Through study completion in the post-implementation period (1 year) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, Emergency Medical Service