Videotelephony-assisted medical direction to improve emergency medical service

Medical service performance evaluation of tertiary general hospitals in Sichuan Province in China based on diagnosis-related groups

OBJECTIVE

This study aims to assess the performance of medical services offered by tertiary general hospitals in Sichuan Province, China, by applying two comprehensive evaluation models. The findings may provide insights for policy-making and future scientific research.

METHODS

Based on the diagnosis-related groups (DRGs) data, the Principal Component Analysis Modified Rank Sum Ratio (PMRSR) and Principal Component Analysis and Entropy Combined Weighted Technique for Order Preference by Similarity to an Ideal Solution Modified Rank Sum Ratio (CWTMRSR) models were developed to separately assess the medical service performance in 130 tertiary general hospitals in Sichuan Province, China. The results of the two evaluation models were compared with the head-to-tail consistency rate.

RESULTS

The medical service performance of the 130 tertiary general hospitals was categorized into four groups using the PMRSR and CWTMRSR models. Among them, 86.92% were classified as "plain" and "medium", 6.15% as "poor", and 6.92% as "excellent". The number of hospitals in each group generated by both models was consistent, with 8 "poor" hospitals, 57 "plain" hospitals, 56 "medium" hospitals, and 9 "excellent" hospitals. The "excellent" hospitals identified by the two models were all Grade A tertiary general hospitals. Furthermore, the head-to-tail consistency rate of the two evaluation models was 94.23%, indicating a strong consistency between the two models. Except for the cost efficiency index (CEI) indicator, the "excellent" hospitals demonstrated superior performance on indicators such as the case-mix index (CMI), number of DRGs (ND), total weight (TW), time efficiency index (TEI), mortality of middle and low-risk groups cases (MMLRG), and standardized cases fatality rate (SCFR) compared to the "poor" hospitals.

CONCLUSIONS

There are disparities in the performance of medical services offered by tertiary general hospitals in Sichuan Province, China. For hospitals categorized as "poor", there is potential for them to strengthen their management capabilities and medical techniques to retain more suitable patients while increasing their ND, TW, and CMI indicators. Furthermore, it is crucial for them to significantly elevate their quality of care to effectively reduce the MMLRG and SCFR indicators to narrow the gap with the "excellent" hospitals. The combined application of the PMRSR and CWTMRSR models can improve the reliability and stability of the medical service performance evaluation.

Optimal wearable camera mount locations for medical supervision during simulated out-of-hospital cardiopulmonary resuscitation

The quality of the visual information transmitted from a scene is crucial for effective medical supervision in prehospital settings. This study investigated the influence of wearable camera mount locations on visibility during simulated out-of-hospital cardiopulmonary resuscitation. A prospective, observational, non-randomized simulation study was conducted to replicate a cardiac arrest scenario adhering to an advanced life support (ALS) protocol. Seven advanced emergency medical technicians (AEMTs) participated, and 5 camera mount locations were tested: the sternum, forehead, lateral side of the eyelid, mid-nasal, and glabella. Video recordings were captured from the Airway, Intravenous (IV), and Leading providers. Five experienced medical directors independently evaluated visibility scores (1-5) for each procedure with optimal visibility defined as a score of 4 to 5. Glabella mount demonstrated the highest median visibility score and interquartile range (5 [4-5]) and proportion of optimal visibility (77.5%) for most procedures across provider positions. Mixed models revealed significant estimates for the lateral side of the eyelid, mid-nasal, and glabella mounts compared to the sternum, with glabella having the largest effect size (estimate = 1.62). Generalized linear mixed models showed that the glabella mount had the highest odds ratio (OR = 8.07, 95% confidence interval [CI]: 3.01-21.6) to achieve optimal visibility. Wearable camera mount location significantly affected visibility during simulated resuscitation. Mounting cameras closer to eye level provided the most accurate visual data. Further research using objective measures, such as artificial intelligence, and evaluating the visibility of wearable cameras in real-world situations is warranted to optimize simulation-based training for prehospital care.

Application of DRGs in hospital medical record management and its impact on service quality

BACKGROUND

To explore the application of diagnosis-related groups (DRGs) in hospital medical record management and the impact on service quality.

OBJECTIVE

This study introduced DGRs management into hospital medical record management in order to improve the quality of hospital medical record management.

METHOD

The medical record management of our hospital was analysed retrospectively between August 2020 and April 2021. A total of 7263 cases without DRG management before January 2021 were included in a control group, and 7922 cases with DRG management after January 2021 were included in a study group. The error rate of medical records, the specific error items and the scores of service capability, service efficiency and service quality were compared along with the comprehensive scores of the two groups.

RESULTS

The error rate of medical records in the study group was significantly lower than that in the control group (19.35% vs. 31.24%, P < 0.05). The error rates in terms of diagnosis on admission, surgical procedures, main diagnosis and other diagnoses in the study group were significantly lower than those in the control group. The scores for service ability, service efficiency and service quality were significantly higher in the study group than in the control group (P < 0.05). The comprehensive evaluation score of the study group was significantly higher than that of the control group (P < 0.01).

CONCLUSION

Applying DRGs in the hospital medical record management can effectively reduce the error rate of medical records and improve the quality of hospital services.

Video Emergency Calls in Medical Dispatching: A Scoping Review

BACKGROUND

Video emergency calls (VCs) represent a feasible future trend in medical dispatching. Acceptance among callers and dispatchers seems to be good. Indications, potential problems, limitations, and directions of research of adding a live video from smartphones to an emergency call have not been reviewed outside the context of out-of-hospital cardiac arrest (OHCA).

OBJECTIVE

The main objective of this study is to examine the scope and nature of research publications on the topic of VC. The secondary goal is to identify research gaps and discuss the potential directions of research efforts of VC.

DESIGN

Following PRISMA-ScR guidelines, online bibliographic databases PubMed, Web of Science, SCOPUS, Google Scholar, ClinicalTrials.gov, and gray literature were searched from the period of January 1, 2012 through March 1, 2022 in English. Only studies focusing on video transfer via mobile phone to emergency medical dispatch centers (EMDCs) were included.

RESULTS

Twelve articles were included in the qualitative synthesis and six main themes were identified: (1) cardiopulmonary resuscitation (CPR) guided by VC; (2) indications of VCs; (3) dispatchers' feedback and perception; (4) technical aspects of VCs; (5) callers' acceptance; and (6) confidentiality and legal issues.

CONCLUSION

Video emergency calls are feasible and seem to be a well-accepted auxiliary method among dispatchers and callers. Some promising clinical results exist, especially for video-assisted CPR. On the other hand, there are still enormous knowledge gaps in the vast majority of implementation aspects of VC into practice.

Administrative Experiences for the Safety of Mild COVID-19 Patients in Community Treatment Centers in South Korea

Community Treatment Centers (CTC) have been set up in South Korea to quarantine and treat COVID-19 patients with mild symptoms. Such CTCs have shown to be successful in terms of management and operation. However, recent incidences of patient deaths at CTCs have brought about concerns and the need to re-examine the administration of CTCs. The following issues include some of the problems of CTCs: failure to monitor patients, recognize emergency situations, and rapidly transfer patients to hospitals, and also the increased fatigue of medical staff. It is necessary to enhance patient safety measures at CTCs by setting up a stronger patient monitoring system, a swifter hospital transfer process and a faster response to emergency situations.

Audiovisual Consults by Paramedics to Reduce Hospital Transport After Low-Urgency Calls: Randomized Controlled Trial

INTRODUCTION

The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls.

OBJECTIVES

The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs.

METHODS

During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed.

RESULTS

Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group.

CONCLUSIONS

The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.