Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study

Abstract

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.

Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic

“…Ambulance nurses and GPs can perform this prehospital triage and leave patients at home when ED referral is not necessary, as was done for cardiac complaints in the HART-c study. 24 When increasing the number of beds and improving prehospital triage offered insufficient solace, collaboration with neighboring hospitals is a next step. The Modena Taskforce response in Italy implemented a dashboard called Pagoda to show the number of positive tests and ICU occupancy throughout the region.…”

Telemedicine for emergency patients in pre-hospital care: A scoping review

“…23 After conducting patients' medical condition and history assessment, physical examination with vital sign monitoring, and other diagnostic procedures, EMS paramedics can either tele-transmit the result to a physician and get notified with text or audio for further advice for diagnosis or therapy 24 , or use audio and video features where they can connect virtually to physicians. [16][17][18][19]22,24,25,27 Catapan et al 33 found that video teleconsultation has numerous benefits. A few of the benefits are the ability to diagnose accurately, similar to face-to-face, the ability to deliver care without moving the patient, and the ability to adapt to current time constraints for health care.…”

“…A monitor or defibrillator monitor can be used to tele-transmit ECG from ambulances for interpretation by a physician. 16,20 The advantage of using a monitor that can tele-transmit ECG is that if there is any new change in the ECG, consultation or treatment for this condition can be started immediately. 20 Another advanced pre-hospital technology is the Mobile Stroke Unit (MSU) for stroke-suspected emergency patients.…”

“…Pre-hospital care for cardiovascular disease was discussed in 6 articles, where the stroke was discussed in 3 articles 17,24,27 , ST-elevation myocardial infarction (STEMI) was discussed in 2 articles 20,26 , and unspecified cardiovascular disease was discussed in 1 article. 16 According to a 2021 WHO report, noncommunicable diseases (NCDs) account for 71% of all deaths worldwide.…”

Prehospital risk assessment in patients suspected of non-ST-segment elevation acute coronary syndrome: a systematic review and meta-analysis

“…8 It is well known that this is associated with shorter ischaemic times and subsequent improved clinical outcomes. [9][10][11] On the other hand, the use of additional diagnostic tools could help to definitively rule out an NSTE-ACS in the prehospital setting in chest pain patients with a low suspicion for NSTE-ACS. This is important as only 11%-21% of these patients presenting to an emergency department are finally diagnosed with an NSTE-ACS, in the remaining majority generally no life-threatening condition is found.…”