Is paper-based documentation in an emergency medical service adequate for retrospective scientific analysis? An evaluation of a physician-run service

Bergrath, Sebastian; Skorning, Max; Rörtgen, Daniel; Beckers, Stefan; Brokmann, Jörg Christian; Mutscher, Christina; Rossaint, Rolf

doi:10.1136/emj.2009.086538

Cited by 24 publications

(22 citation statements)

References 27 publications

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“…Bergrath et al 17 examined paper prehospital records in Germany and found that the documentation compliance of vital parameters ranged from 40.31% to 99.33%. Our own retrospective analysis of paper records at the University of Washington (n=165) found a similar range of compliance: the ‘reason a resuscitation ended’ was recorded only 45% of the time, while the ‘time to first shock’ was recorded 93% of the time 18…”

Section: Introductionmentioning

confidence: 99%

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record

et al. 2013

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Section: Introductionmentioning

confidence: 99%

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record

et al. 2013

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“…Lack of documentation is often highlighted as a limitation for research in emergency medicine, especially for retrospective registry studies [5, 35, 43–45]. Putting attention to increase the quality of routinely collected data may enable such data to be an important and effective source to monitor and compare services.…”

Section: Discussionmentioning

confidence: 99%

“…Putting attention to increase the quality of routinely collected data may enable such data to be an important and effective source to monitor and compare services. As such, strategies to increase data capture should be sought [30, 43, 45–48]. Training programs may increase data capture, most likely by increasing attention to documentation [43, 48].…”

Section: Discussionmentioning

confidence: 99%

Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway

Tønsager

Rehn

Ringdal

et al. 2019

BMC Health Serv Res

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Background Comparison of services and identification of factors important for favourable patient outcomes in emergency medical services (EMS) is challenging due to different organization and quality of data. The purpose of the present study was to evaluate the feasibility of physician-staffed EMS (p-EMS) to collect patient and system level data by using a consensus-based template. Methods The study was an international multicentre observational study. Data were collected according to a template for uniform reporting of data from p-EMS using two different data collection methods; a standard and a focused data collection method. For the standard data collection, data were extracted retrospectively for one year from all FinnHEMS bases and for the focused data collection, data were collected prospectively for six weeks from four selected Norwegian p-EMS bases. Completeness rates for the two data collection methods were then compared and factors affecting completeness rates and template feasibility were evaluated. Standard Chi-Square, Fisher’s Exact Test and Mann-Whitney U Test were used for group comparison of categorical and continuous data, respectively, and Kolomogorov-Smirnov test for comparison of distributional properties. Results All missions with patient encounters were included, leaving 4437 Finnish and 128 Norwegian missions eligible for analysis. Variable completeness rates indicated that physiological variables were least documented. Information on pain and respiratory rate were the most frequently missing variables with a standard data collection method and systolic blood pressure was the most missing variable with a focused data collection method. Completeness rates were similar or higher when patients were considered severely ill or injured but were lower for missions with short patient encounter. When a focused data collection method was used, completeness rates were higher compared to a standard data collection method. Conclusions We found that a focused data collection method increased data capture compared to a standard data collection method. The concept of using a template for documentation of p-EMS data is feasible in physician-staffed services in Finland and Norway. The greatest deficiencies in completeness rates were evident for physiological parameters. Short missions were associated with lower completeness rates whereas severe illness or injury did not result in reduced data capture. Electronic supplementary material The online version of this article (10.1186/s12913-019-3976-6) contains supplementary material, which is available to authorized users.

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“…Increasing numbers of emergency calls, prolonged emergency response times by EMS physicians, and shortages of EMS physicians are having a big impact on the German EMS system. Furthermore, EMS treatment [ 33 , 34 ] and documentation quality [ 35 , 36 ] require urgent improvement.…”

Section: Discussionmentioning

confidence: 99%

Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial

Stevanovic

Beckers

Czaplik

et al. 2017

Trials

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BackgroundIncreasing numbers of emergency calls, shortages of Emergency Medical Service (EMS), physicians, prolonged emergency response times and regionally different quality of treatment by EMS physicians require improvement of this system. Telemedical solutions have been shown to be beneficial in different emergency projects, focused on specific disease patterns. Our previous pilot studies have shown that the implementation of a holistic prehospital EMS teleconsultation system, between paramedics and experienced tele-EMS physicians, is safe and feasible in different emergency situations. We aim to extend the clinical indications for this teleconsultation system. We hypothesize that the use of a tele-EMS physician is noninferior regarding the occurrence of system-induced patient adverse events and superior regarding secondary outcome parameters, such as the quality of guideline-conforming treatment and documentation, when compared to conventional EMS-physician treatment.Methods/designThree thousand and ten patients will be included in this single-center, open-label, randomized controlled, noninferiority trial with two parallel arms. According to the inclusion criteria, all emergency cases involving adult patients who require EMS-physician treatment, excluding life-threatening cases, will be randomly assigned by the EMS dispatching center into two groups. One thousand five hundred and five patients in the control group will be treated by a conventional EMS physician on scene, and 1505 patients in the intervention group will be treated by paramedics who are concurrently instructed by the tele-EMS physicians at the teleconsultation center. The primary outcome measure will include the rate of treatment-specific adverse events in relation to the kind of EMS physician used. The secondary outcome measures will record the specific treatment-associated quality indicators.DiscussionThe evidence underlines the better quality of service using telemedicine networks between medical personnel and medical experts in prehospital emergency care, as well as in other medical areas. The worldwide unique EMS teleconsultation system in Aachen has been optimized and evaluated in pilot studies and subsequently integrated into routine use for a broad spectrum of indications. It has enabled prompt, safe and efficient patient treatment with optimized use of the “resource” EMS physician. There is, however, a lack of evidence as to whether the advantages of the teleconsultation system can be replicated in wider-ranging EMS-physician indications (excluding life-threatening emergency calls).Trial registrationClinicalTrials.gov, identifier: NCT02617875. Registered on 24 November 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1781-2) contains supplementary material, which is available to authorized users.

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Is paper-based documentation in an emergency medical service adequate for retrospective scientific analysis? An evaluation of a physician-run service

Cited by 24 publications

References 27 publications

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record

Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway

Telemedical support for prehospital Emergency Medical Service (TEMS trial): study protocol for a randomized controlled trial

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