Background:.Handling emergency calls in French emergency medical call centres (EMCCs) can be challenging considering the frequent lack of relevant information. Tele-transmission devices use in regular ambulance seems like a good solution to bring the EMCC physician a more accurate assessment of the scene, in particular for mild trauma injury (MTI). We measured the impact of ambulance staff tele-transmitted photographies on prehospital dispatching optimisation for patients calling the EMCC with MTI.Methods: We conducted a prospective, single-centre, randomised-controlled trial comparing two groups of patients calling the EMCC with MTI who did or did not benefit from photography tele-transmission by ambulance staff. The primary outcome was the proportion of patients referred away from the nearest hospital (left at home for outpatient care; referred to a higher level hospital; handled by a medical intensive care ambulance for advanced pre-hospital care) used as a marker of better orientation.Results:.Between 29 April 2019 and 21 July 2020, 165 patients were randomised and 152 analysed. Photography tele-transmission resulted in better patient dispatching (24/73 [33%] patients in the intervention group vs 9/79 [11%] patients in the control group, OR 3.80 [1.63 – 8.90]; p = 0.03), without increasing the proportion of patients initially left at home for outpatient care and visiting an ED within 10 days for secondary trauma-related care (1/14 [7%] vs 1/4 [25%], OR 0.25 [0.01-24.1]; p = 0.41). The proportion of patients unnecessarily referred to an ED was 7% [4/59 patients] in the intervention group vs 16% [12/75 patients] in the control group (OR 0.38 [0.09-1.36]; p = 0.10).Conclusion: Photographies tele-transmission by regular ambulance staff improves the dispatching of patients calling French EMCCs with MTI.Trial registration: The study is registered with Clinicaltrials.gov (NCT04034797).
The objective of the study was to perform a cost-effectiveness analysis of bundled devices (BDs) versus standard devices (SDs) for the prevention of unscheduled peripheral venous catheter (PVC) removal due to complication from a French investigator-initiated, open-label, single center, randomized-controlled, two-by-two factorial trial (CLEAN-3 study). A 14-day time non homogeneous semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN-3 database. This model includes five health states and eight transitional events; a base case scenario, two scenario analyses and bootstrap sensitivity analyses were performed. The cost-effectiveness criterion was the cost per patient with unscheduled PVC removal avoided. 989 adult (age≥18 years) patients were analyzed to compare the BDs group (494 patients), and the SDs group (495 patients). The assessed intervention was a combination of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes compared with the use of open catheters and three-way stopcocks for treatment administration. For the base case scenario, an unscheduled 1st PVC removal before discharge was significantly more frequent in the SDs group (235 patients (47.5%) in the SDs group and 172 patients (34.8%) in the BDs group, p = 0.00006). After adjustment for 1st catheter time, the number of patients with unscheduled PVC removal per day was of 16 (95%CI: 15; 18) patients (out of 100) in the BDs group and of 26 (95%CI: 24; 28) patients (out of 100) in the SDs group. The mean cost per patient (adjusted on catheter-time) was of €144 (95%CI: €135-€154) for patients in the SDs group versus €102 (95%CI: €95-€109) for patients in the BDs group; the mean saving per patient was of €42 (95%CI: €32-€54). As a consequence, the assessed BDs strategy was less costly and more effective than the SDs strategy.
Trail registration: CLEAN-3 study is registered with ClinicalTrials.gov, NCT03757143.
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