Randomised controlled study on quality of care using either a telemedical or conventional physician based out-of-hospital emergency system

使用基于远程医疗或传统医生的院外急救系统的护理质量的随机对照研究

• 批准号: 288115165
• 负责人: Professor Dr. Rolf Rossaint
• 金额: --
• 依托单位: Klinik für Anästhesiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2019-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/288115165?language=en
• 关键词: Randomised; controlled; study; quality; care

In Germany out of all prehospital emergencies 50% are managed by paramedics alone, 50% by additional emergency physicians. This high use of additional physicians occurs in spite of the fact that in only 1/10 of all cases the manual abilities of a physician are needed. Due to the closing down of many emergency care centers, the steady increase of emergency cases and additional shortage of qualified emergency physicians it is especially in rural areas nearly impossible to maintain a short time interval between emergency call and arrival of an emergency physician.Although telemedicine has been proven to be helpful and quality-improving in many Areas of clinical medicine, so far, in the field of prehospital emergency medicine only specific telemedicine components responding to a unique need based on a specific disease (e.g. stroke) were used. To overcome this shortage, we developed a holistic telemedicine system for a broad spectrum of different prehospital emergency cases, which acts synergistically to the existing ground- and air-based rescue systems. This systems consists of hard- and software components (work-station for the tele-emergency physician, server-infrastructure, mobile and in the ambulance integrated transfer unit), which allows for an online and safe transfer of all data (language, vital parameter, images and videostream). After legal clarification, evaluation of the system in two research projects and further technical development this system is used for routine care since April, 1rst 2014. However, at present the system, which is an add-on to the already existing rescue devices, is only used, if in situations planned for paramedics only the need for additional physician treatment occurs. So far, the > 2000 initially paramedics-only planned operations were without adverse events, however, showed a better medical history, treatment and documentation quality. At the same time the physician tied-up period was reduced by 50%.Using a randomized controlled trial design this research grant proposal including 3000 patients aims for comparing the procedure-specific complication rate and quality of care of a prehospital emergency telemedicine physician based system with a conventional emergency physician based system, when excluding certain cases (e.g. multiple trauma and respiratory or cardiac arrest) accounting for about 10% of all emergency cases.Should this RCT demonstrate that under these conditions the telemedicine approach is with respect to complications equivalent to the conventional physician based out-of-hospital emergency system and at the same time leads to an improved quality of care in some aspects, it would allow a restructuring of the German out-of-hospital rescue service. Instead of 50% only about 10% of all emergency cases would be in need of a physically present emergency physician, the other cases in need of a physician could be treated with the help of an emergency telemedicine physician.

在德国，在所有院前急救中，50%由护理人员单独管理，50%由额外的急诊医生管理。尽管只有十分之一的病例需要医生的手工技能，但仍大量使用额外的医生。由于许多紧急护理中心的关闭，紧急病例的稳步增加和合格的急诊医生的额外短缺，特别是在农村地区，几乎不可能在紧急呼叫和急诊医生到达之间保持很短的时间间隔。尽管远程医疗已被证明是有帮助的，并且在许多临床医学领域提高了质量，但到目前为止，在院前急救医疗领域，只使用了针对特定疾病（如中风）的特殊需要的特定远程医疗组成部分。为了克服这一不足，我们开发了一个全面的远程医疗系统，用于各种不同的院前急救病例，与现有的地面和空中救援系统协同工作。该系统由硬件和软件组成部分（远程急救医生工作站、服务器基础设施、移动的和救护车综合传输单元）组成，可在线安全传输所有数据（语言、生命参数、图像和视频流）。经过法律的澄清、两个研究项目中的系统评价和进一步的技术开发，该系统自2014年4月1日起用于常规护理。然而，目前，该系统是现有救援设备的附加装置，仅在为护理人员计划的情况下使用，仅需要额外的医生治疗。到目前为止，> 2000例最初仅由护理人员计划的手术没有不良事件，但显示出更好的病史、治疗和记录质量。同时，医生的占用时间减少了50%。使用随机对照试验设计，这项研究资助计划包括3000名患者，旨在比较院前急救远程医疗系统与传统急诊医生系统的手术特定并发症发生率和护理质量，在排除某些情况时（例如多发性创伤和呼吸或心脏骤停）约占10%如果这项随机对照试验表明，在这些条件下，远程医疗方法在并发症方面与传统方法相当，这将有助于建立一个以医生为基础的院外急救系统，同时在某些方面提高护理质量，这将使德国院外救援服务得以重组。而不是50%，只有约10%的所有紧急情况下将需要一个物理存在的急诊医生，其他情况下需要一个医生可以治疗的帮助下，紧急远程医疗医生。