title: Telemedicine-based physician consultation results in more patients treated and released by ambulance personnel.
abstract: OBJECTIVE
  We examined whether teleconsultation from ambulances to a physician at an emergency medical communication center (EMCC) would increase the proportion of patients with nonurgent conditions being treated and released on site.
  
  
  METHODS
  This research was a before-after pilot study. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation from the ambulance with the physician. The primary outcome was the proportion of patients treated and released on site. Secondary outcomes were the number of hospital admissions, mortality, and patient satisfaction. The intervention period was compared with a corresponding control period from the previous year.
  
  
  RESULTS
  We observed an increase in the proportion of patients treated and released in the intervention period in 2014 compared with the control period in 2013, up from 21% (n=137) to 29% (n=221) (odds ratio=1.46; 95% confidence interval=1.14-1.89, P=0.002). The follow-up rate was 100%. There was no observable increase in hospital admissions or mortality among patients treated and released from 2013 to 2014. A telephone survey of patients treated and released showed that 98.4% (95% confidence interval=91.3-99.9) were very satisfied or satisfied with their treatment.
  
  
  CONCLUSIONS
  Teleconsultation between a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety.
authors.affiliation: Research Department, Prehospital Emergency Medical Services.|Aarhus University Hospital, Research Center for Emergency Medicine.|Emergency Department, Aarhus University Hospital, Aarhus.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Raaber
authors.affiliation: Research Department, Prehospital Emergency Medical Services.|Aarhus University Hospital, Research Center for Emergency Medicine.
authors.forename: Morten T
authors.initials: MT
authors.lastname: Bøtker
authors.affiliation: Research Department, Prehospital Emergency Medical Services.
authors.forename: Ingunn S
authors.initials: IS
authors.lastname: Riddervold
authors.affiliation: Department of Anesthesiology and Intensive Care, Emergency Clinic, Aalborg University Hospital, Aalborg.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Christensen
authors.affiliation: Prehospital Emergency Medical Services, Central Denmark Region.
authors.forename: Niels-Christian
authors.initials: NC
authors.lastname: Emmertsen
authors.affiliation: Department of Anesthesiology, Regional Hospital Randers, Randers, Denmark.
authors.forename: Thorbjørn
authors.initials: T
authors.lastname: Grøfte
authors.affiliation: Aarhus University Hospital, Research Center for Emergency Medicine.
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data; D010865:Pilot Projects; D019114:Remote Consultation / Q000458:organization & administration*