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Schröder H, Beckers SK, Borgs C, Sommer A, Rossaint R, Grüßer L, Felzen M. Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service. Sci Rep 2024; 14:310. [PMID: 38172217 PMCID: PMC10764932 DOI: 10.1038/s41598-023-50924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
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.
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Affiliation(s)
- Hanna Schröder
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Stefan K Beckers
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
| | - Christina Borgs
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anja Sommer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Linda Grüßer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Marc Felzen
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
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Bell S, Hill JE. Diagnostic accuracy of early warning system scores in the prehospital setting. JOURNAL OF PARAMEDIC PRACTICE : THE CLINICAL MONTHLY FOR EMERGENCY CARE PROFESSIONALS 2023; 15:516-519. [PMID: 38808272 PMCID: PMC7616024 DOI: 10.12968/jpar.2023.15.12.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
The utilisation of pre-hospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and pre-hospital care settings, a systematic review by Guan et al. (2022) was undertaken to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or pre-hospital setting. This commentary aims to critically appraise the methods used within the review Guan et al (2022) and expand upon the findings in the context of clinical practice.
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Affiliation(s)
- S Bell
- North West Ambulance Service NHS Trust
| | - J E Hill
- University of Central Lancashire
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Zayas CE, Whorton JM, Sexton KW, Mabry CD, Dowland SC, Brochhausen M. Development and validation of the early warning system scores ontology. J Biomed Semantics 2023; 14:14. [PMID: 37730667 PMCID: PMC10510162 DOI: 10.1186/s13326-023-00296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Clinical early warning scoring systems, have improved patient outcomes in a range of specializations and global contexts. These systems are used to predict patient deterioration. A multitude of patient-level physiological decompensation data has been made available through the widespread integration of early warning scoring systems within EHRs across national and international health care organizations. These data can be used to promote secondary research. The diversity of early warning scoring systems and various EHR systems is one barrier to secondary analysis of early warning score data. Given that early warning score parameters are varied, this makes it difficult to query across providers and EHR systems. Moreover, mapping and merging the parameters is challenging. We develop and validate the Early Warning System Scores Ontology (EWSSO), representing three commonly used early warning scores: the National Early Warning Score (NEWS), the six-item modified Early Warning Score (MEWS), and the quick Sequential Organ Failure Assessment (qSOFA) to overcome these problems. METHODS We apply the Software Development Lifecycle Framework-conceived by Winston Boyce in 1970-to model the activities involved in organizing, producing, and evaluating the EWSSO. We also follow OBO Foundry Principles and the principles of best practice for domain ontology design, terms, definitions, and classifications to meet BFO requirements for ontology building. RESULTS We developed twenty-nine new classes, reused four classes and four object properties to create the EWSSO. When we queried the data our ontology-based process could differentiate between necessary and unnecessary features for score calculation 100% of the time. Further, our process applied the proper temperature conversions for the early warning score calculator 100% of the time. CONCLUSIONS Using synthetic datasets, we demonstrate the EWSSO can be used to generate and query health system data on vital signs and provide input to calculate the NEWS, six-item MEWS, and qSOFA. Future work includes extending the EWSSO by introducing additional early warning scores for adult and pediatric patient populations and creating patient profiles that contain clinical, demographic, and outcomes data regarding the patient.
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Affiliation(s)
- Cilia E Zayas
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Justin M Whorton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin W Sexton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- University of Arkansas for Medical Sciences, Institute for Digital Health & Innovation, 4301 West Markham Street, Slot 781, Little Rock, AR, 72205, USA
| | - Charles D Mabry
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Clint Dowland
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mathias Brochhausen
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Castro Portillo E, López-Izquierdo R, Castro Villamor MA, Sanz-García A, Martín-Conty JL, Polonio-López B, Sánchez-Soberón I, del Pozo Vegas C, Durantez-Fernández C, Conty-Serrano R, Martín-Rodríguez F. Modified Sequential Organ Failure Assessment Score vs. Early Warning Scores in Prehospital Care to Predict Major Adverse Cardiac Events in Acute Cardiovascular Disease. J Cardiovasc Dev Dis 2023; 10:88. [PMID: 36826584 PMCID: PMC9966856 DOI: 10.3390/jcdd10020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: The Modified Sequential Organ Failure Assessment (mSOFA) is an Early Warning Score (EWS) that has proven to be useful in identifying patients at high risk of mortality in prehospital care. The main objective of this study was to evaluate the predictive validity of prehospital mSOFA in estimating 2- and 90-day mortality (all-cause) in patients with acute cardiovascular diseases (ACVD), and to compare this validity to that of four other widely-used EWS. (2) Methods: We conducted a prospective, observational, multicentric, ambulance-based study in adults with suspected ACVD who were transferred by ambulance to Emergency Departments (ED). The primary outcome was 2- and 90-day mortality (all-cause in- and out-hospital). The discriminative power of the predictive variable was assessed and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC). (3) Results: A total of 1540 patients met the inclusion criteria. The 2- and 90-day mortality rates were 5.3% and 12.7%, respectively. The mSOFA showed the highest AUC of all the evaluated scores for both 2- and 90-day mortality, AUC = 0.943 (0.917-0.968) and AUC = 0.874 (0.847-0.902), respectively. (4) Conclusions: The mSOFA is a quick and easy-to-use EWS with an excellent ability to predict mortality at both 2 and 90 days in patients treated for ACVD, and has proved to be superior to the other EWS evaluated in this study.
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Affiliation(s)
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, 47003 Valladolid, Spain
| | | | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | | | | | | | - Rosa Conty-Serrano
- Faculty of Nursing, Universidad of Castilla-La Mancha, 45004 Toledo, Spain
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