Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study
Introduction Emergency 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 wit...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e041553.full |
| _version_ | 1826862996453851136 |
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| author | Jan Bosch Charles JHJ Kirchhof Mark J Boogers Enrico de Koning Tom E Biersteker Saskia Beeres Barbra E Backus Reza Alizadeh Dehnavi Helen AM Silvius Martin Schalij |
| author_facet | Jan Bosch Charles JHJ Kirchhof Mark J Boogers Enrico de Koning Tom E Biersteker Saskia Beeres Barbra E Backus Reza Alizadeh Dehnavi Helen AM Silvius Martin Schalij |
| author_sort | Jan Bosch |
| collection | DOAJ |
| description | Introduction Emergency 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 analysis Patients 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 dissemination The 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.Discussion The 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. |
| first_indexed | 2024-04-13T04:08:16Z |
| format | Article |
| id | doaj.art-e796b18d5e744e58a7be9f9b0bb6b8a3 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-02-16T20:50:46Z |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-e796b18d5e744e58a7be9f9b0bb6b8a32025-01-20T00:25:12ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-041553Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective studyJan Bosch0Charles JHJ Kirchhof1Mark J Boogers2Enrico de Koning3Tom E Biersteker4Saskia Beeres5Barbra E Backus6Reza Alizadeh Dehnavi7Helen AM Silvius8Martin Schalij9Regionale Ambulancedienstvoorziening Hollands Midden, Leiden, The NetherlandsDepartment of Cardiology, Alrijne Hospital, Leiderdorp, NetherlandsCardiology, Leiden Universitair Medisch Centrum, Leiden, The NetherlandsCardiology, Leiden University Medical Center, Leiden, The NetherlandsCardiology, Leiden University Medical Center, Leiden, The NetherlandsCardiology, Leiden University Medical Center, Leiden, The NetherlandsEmergency Medicine, Leiden University Medical Center, Leiden, The NetherlandsCardiology, Groene Hart Hospital, Gouda, The NetherlandsPublic Health and General Practice, Leiden University Medical Center, Leiden, The NetherlandsCardiology, Leiden University Medical Center, Leiden, The NetherlandsIntroduction Emergency 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 analysis Patients 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 dissemination The 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.Discussion The 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.https://bmjopen.bmj.com/content/11/2/e041553.full |
| spellingShingle | Jan Bosch Charles JHJ Kirchhof Mark J Boogers Enrico de Koning Tom E Biersteker Saskia Beeres Barbra E Backus Reza Alizadeh Dehnavi Helen AM Silvius Martin Schalij Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study BMJ Open |
| title | Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study |
| title_full | Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study |
| title_fullStr | Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study |
| title_full_unstemmed | Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study |
| title_short | Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study |
| title_sort | prehospital triage of patients with acute cardiac complaints study protocol of hart c a multicentre prospective study |
| url | https://bmjopen.bmj.com/content/11/2/e041553.full |
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