Telenotarzt auf dem Prüfstand Evaluation des Projekts Med-on-@ix aus Sicht der Rettungsassistenten

Schneiders, Marie-Thérèse; Herbst, S.; Schilberg, Daniel; Isenhardt, Ingrid; Jeschke, Sabina; Fischermann, Harold; Bergrath, Sebastian; Rossaint, Rolf; Skorning, Max

doi:10.1007/978-3-642-33389-7_66

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“…For end-users, a satisfactory technical performance and usability were identified as key elements for implementation during user interviews and questionnaires. 28 Only in the course of the three phases we were able to meet user requirements. 25 27 29 While integrating new telemedical procedures, including expanded skills of paramedics, the users’ perspectives differed noticeably between paramedics and physicians.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a full-scale prehospital telemedicine system: evaluation of the process and systemic effects in a pre–post intervention study

et al. 2021

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ObjectivesTo review the implementation strategy from a research project towards routine care of a comprehensive mobile physician-staffed prehospital telemedicine system. The objective is to evaluate the implementation process and systemic influences on emergency medical service (EMS) resource utilisation.DesignRetrospective pre–post implementation study.SettingTwo interdisciplinary projects and the EMS of a German urban region.InterventionsImplementation of a full-scale prehospital telemedicine system.EndpointsDescriptive evaluation of the implementation strategy. Primary endpoint: ground-based and helicopter-based physician staffed emergency missions before and after implementation.ResultsThe first research project revealed positive effects on guideline adherence and patient safety in two simulation studies, with feasibility demonstrated in a clinical study. After technical optimisation, safety and positive effects were demonstrated in a multicentre trial. Routine care in the city of Aachen, Germany was conducted stepwise from April 2014 to March 2015, including modified dispatch criteria. Systemic parameters of all EMS assignments between pre-implementation (April 2013 to March 2014) and post implementation (April 2015 to March 2016): on-scene EMS physician operations decreased from 7882/25 187 missions (31.3%) to 6360/26 462 (24.0%), p<0.0001. The need for neighbouring physician-staffed units dropped from 234/25 187 (0.93%) to 119/26 462 (0.45%), p<0.0001, and the need for helicopter EMS from 198/25 187 (0.79%) to 100/26 462 (0.38%), p<0.0001. In the post implementation period 2347 telemedical interventions were conducted, with 26 462 emergency missions (8.87%).ConclusionA stepwise implementation strategy allowed transfer from the project phase to routine care. We detected a reduced need for conventional on-scene physician care by ground-based and helicopter-based EMS, but cannot exclude unrecognised confounders, including modified dispatch criteria and possible learning effects. This creates the potential for increased availability of EMS physicians for life-threatening emergencies by shifting physician interventions from conventional to telemedical care.Trial registration numberNCT04127565.

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Section: Discussionmentioning

confidence: 99%