Was erwarten Mitarbeiter der Notfallmedizin vom Telenotarzt?

Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service

The benefits of a telemedical support system for prehospital emergency medical services include high-level emergency medical support at the push of a button: delegation of drug administration, diagnostic assistance, initiation of therapeutic measures, or choice of hospital destination. At various European EMS sites telemedical routine systems are shortly before implementation. The aim of this study was to investigate the long-term effects of implementing a tele-EMS system on the structural and procedural quality indicators and therefore performance of an entire EMS system. This retrospective study included all EMS missions in Aachen city between 2015 and 2021. Regarding structural indicators of the EMS system, we investigated the overall number of emergency missions with tele-EMS and onsite EMS physicians. Furthermore, we analyzed the distribution of tracer diagnosis and process quality with respect to the time spans on the scene, time until teleconsultation, duration of teleconsultation, prehospital engagement time, and number of simultaneous teleconsultations. During the 7-year study period, 229,384 EMS missions were completed. From 2015 to 2021, the total number of EMS missions increased by 8.5%. A tele-EMS physician was consulted on 23,172 (10.1%) missions. The proportion of telemedicine missions increased from 8.6% in 2015 to 12.9% in 2021. Teleconsultations for missions with tracer diagnoses decreased during from 43.7% to 30.7%, and the proportion of non-tracer diagnoses increased from 56.3% to 69.3%. The call duration for teleconsultation decreased from 12.07 min in 2015 to 9.42 min in 2021. For every fourth mission, one or more simultaneous teleconsultations were conducted by the tele-EMS physician on duty. The implementation and routine use of a tele-EMS system increased the availability of onsite EMS physicians and enabled immediate onsite support for paramedics. Parallel teleconsultations, reduction in call duration, and increase in ambulatory onsite treatments over the years demonstrate the increasing experience of paramedics and tele-EMS physicians with the system in place. A prehospital tele-EMS system is important for mitigating the current challenges in the prehospital emergency care sector.

[The Tele-Emergency Physician System as an Innovation in the Emergency Medical Service: Evaluation of Potentials by Employees of German Ambulance Control Centres]

BACKGROUND

One of the health policy challenges lies in guaranteeing comprehensive emergency care in Germany. Telemedical applications are assumed to be a potential solution to current problems. One of these innovations is the tele-emergency physician system, which changes the workflows of the various actors in prehospital emergency medicine. The aim of the study was to determine how the potentials of the tele-emergency physician system were evaluated by employees of the ambulance control centres in Germany.

METHOD

In the cross-sectional study, employees of ambulance control centres throughout Germany were interviewed using an online-based questionnaire. The results are illustrated in a sub-group analysis according to the state of knowledge on innovation, either (very) low or (very) high. Correlation analyses were carried out to determine significant differences between the subgroups. Data analysis was performed using Microsoft Excel 2013 and IBM SPSS Version 25.

RESULTS

The response rate was 69.04%. Of those surveyed, 76.23% expected that the tele-emergency physician system would save them a relevant amount of time. 57.38% believed that patients would be transported faster and 51.64% of the respondents did not see any chance of cost savings in the health care system. Significant evaluation differences resulted in expected time saving (p=0.004), shorter time to transport (p=0.009) and cost saving (p=0.0004). 64.71% thought that there would be a risk of increased documentation effort. 56.41% did not believe that patients would be sufficiently informed about the legal provisions on data protection during their tele-emergency physician treatment. The increase in documentation effort (p=0.02) and patients being sufficiently informed about data protection regulations (p=0.015) were evaluated significantly differently. 90.98% of the respondents rated the tele-emergency physician system as meaningful. The rural region was considered by 47.62% of the respondents as the primary region where the use of system would be necessary. 36.29% of the participants stated that a tele-emergency physician system should be implemented in their own area.

CONCLUSION

All in all, the tele-emergency physician system is considered useful in prehospital emergency medical service by the staff of the emergency control centres. However, the majority of participants do not assume that there is potential for implementation of this system in their own region.

[Tele-emergency physician : New care concept in emergency medicine]

BACKGROUND

Telemedical concepts, already successfully established in various clinical areas, such as radiology, are increasingly being implemented in the preclinical setting throughout Germany (tele-emergency physician).

OBJECTIVE

The aim of the article is to present the objectives and requirements as well as the practical implementation and the potential indications for a telemedical emergency system in the preclinical situation.

MATERIAL AND METHODS

Discussion of scientific facts and expert recommendations, specifically from experiences of the tele-emergency physician (Telenotarzt) project in an urban environment (City of Aachen). In addition, reference is made to a second pilot project in a rural region (Straubing, Bavaria).

RESULTS

The successful implementation of a prehospital telemedical emergency system requires a specific framework, in particular of a legal and technical nature. In order to achieve optimal process quality it is important to establish a comprehensive concept that takes aspects of patient safety into account. The entire dispatch process in the control center as well as the training of all involved personnel must also be taken into consideration.

CONCLUSION

With its special structures and processes, the overall concept of the telemedical emergency physician meets the changing challenges in the preclinical healthcare system and opens up new possibilities for patient care that meet the current requirements.