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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-implementation period | 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 | 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. |
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| 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. |
| 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 |
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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.
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Pre-intervention period:
Only standard care was provided. No patient data was obtained, only number of emergency calls and used resources were analyzed.
Post-intervention period:
Evaluation of conducted medical procedures in patients who received telemedical support (after given verbal consent). Number of emergency calls and used resources were compared to the pre-intervention period.
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| Name | Affiliation | Role |
|---|---|---|
| Rolf Rossaint, Prof. Dr. | University Hospital Aachen, Germany | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29865891 | Background | Bergrath S, Muller M, Rossaint R, Beckers SK, Uschner D, Brokmann JC. Guideline adherence in acute coronary syndromes between telemedically supported paramedics and conventional on-scene physician care: A longitudinal pre-post intervention cohort study. Health Informatics J. 2019 Dec;25(4):1528-1537. doi: 10.1177/1460458218775157. Epub 2018 Jun 4. | |
| 28560799 |
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Number of delegated medications including opioids in the post-implementation phase
| Through study completion in the post-implementation period (1 year) |
| Brokmann JC, Rossaint R, Muller M, Fitzner C, Villa L, Beckers SK, Bergrath S. Blood pressure management and guideline adherence in hypertensive emergencies and urgencies: A comparison between telemedically supported and conventional out-of-hospital care. J Clin Hypertens (Greenwich). 2017 Jul;19(7):704-712. doi: 10.1111/jch.13026. Epub 2017 May 30. |
| 28484212 | Background | Lenssen N, Krockauer A, Beckers SK, Rossaint R, Hirsch F, Brokmann JC, Bergrath S. Quality of analgesia in physician-operated telemedical prehospital emergency care is comparable to physician-based prehospital care - a retrospective longitudinal study. Sci Rep. 2017 May 8;7(1):1536. doi: 10.1038/s41598-017-01437-5. |
| 27908843 | Background | Brokmann JC, Conrad C, Rossaint R, Bergrath S, Beckers SK, Tamm M, Czaplik M, Hirsch F. Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial. J Med Internet Res. 2016 Dec 1;18(12):e314. doi: 10.2196/jmir.6358. |
| 27080747 | Background | Felzen M, Brokmann JC, Beckers SK, Czaplik M, Hirsch F, Tamm M, Rossaint R, Bergrath S. Improved technical performance of a multifunctional prehospital telemedicine system between the research phase and the routine use phase - an observational study. J Telemed Telecare. 2017 Apr;23(3):402-409. doi: 10.1177/1357633X16644115. Epub 2016 Apr 13. |
| 26036316 | Background | Brokmann JC, Rossaint R, Bergrath S, Valentin B, Beckers SK, Hirsch F, Jeschke S, Czaplik M. [Potential and effectiveness of a telemedical rescue assistance system. Prospective observational study on implementation in emergency medicine]. Anaesthesist. 2015 Jun;64(6):438-45. doi: 10.1007/s00101-015-0039-1. Epub 2015 Jun 3. German. |
| 22750663 | Background | Rortgen D, Bergrath S, Rossaint R, Beckers SK, Fischermann H, Na IS, Peters D, Fitzner C, Skorning M. Comparison of physician staffed emergency teams with paramedic teams assisted by telemedicine--a randomized, controlled simulation study. Resuscitation. 2013 Jan;84(1):85-92. doi: 10.1016/j.resuscitation.2012.06.012. Epub 2012 Jun 30. |
| 22115932 | Background | Skorning M, Bergrath S, Rortgen D, Beckers SK, Brokmann JC, Gillmann B, Herding J, Protogerakis M, Fitzner C, Rossaint R; Med-on-@ix-Working Group. Teleconsultation in pre-hospital emergency medical services: real-time telemedical support in a prospective controlled simulation study. Resuscitation. 2012 May;83(5):626-32. doi: 10.1016/j.resuscitation.2011.10.029. Epub 2011 Nov 22. |
| 21933897 | Background | Bergrath S, Rortgen D, Rossaint R, Beckers SK, Fischermann H, Brokmann JCh, Czaplik M, Felzen M, Schneiders MT, Skorning M. Technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service - an observational study. J Telemed Telecare. 2011;17(7):371-7. doi: 10.1258/jtt.2011.110203. Epub 2011 Sep 20. |
| 33762230 | Derived | Bergrath S, Brokmann JC, Beckers S, Felzen M, Czaplik M, Rossaint R. Implementation of a full-scale prehospital telemedicine system: evaluation of the process and systemic effects in a pre-post intervention study. BMJ Open. 2021 Mar 24;11(3):e041942. doi: 10.1136/bmjopen-2020-041942. |