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Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  28 September 2020

Roman Sykora Open the ORCID record for Roman Sykora [Opens in a new window] ,
Metodej Renza ,
Jiri Ruzicka ,
Petra Bakurova ,
Milos Kukacka ,
Jiri Smetana  and
Frantisek Duska
Roman Sykora*
Affiliation:
Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic
Metodej Renza
Affiliation:
Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic
Jiri Ruzicka
Affiliation:
Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic Emergency Medical Service of Pilsen Region, Pilsen, Czech Republic Department of Biophysics, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
Petra Bakurova
Affiliation:
Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic
Milos Kukacka
Affiliation:
Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic
Jiri Smetana
Affiliation:
Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic
Frantisek Duska
Affiliation:
Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic
*
Correspondence: Roman Sykora, MD, PhD, Emergency Medical Service of Karlovy Vary Region, Závodní 390/98C, Karlovy Vary – 36006, Czech Republic, E-mail: [email protected]
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Abstract

Introduction:

The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls.

Objectives:

The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs.

Methods:

During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed.

Results:

Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group.

Conclusions:

The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.

Keywords

audiovisual consultprehospital emergency caretelemedicine
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 656 - 662
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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