Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective
Enrico de Koning1, Tom E Biersteker1, Saskia Beeres1
1Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
The HART-c study introduces a new prehospital triage method for cardiac emergencies, aiming to reduce emergency department overcrowding. This approach involves paramedics and cardiologists collaborating to decide on hospital admissions, improving patient care and resource allocation.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Management
Background:
- Emergency department overcrowding is a critical healthcare issue, leading to adverse patient outcomes and increased costs.
- Current strategies focus on in-hospital triage for cardiac patients, but prehospital interventions are underexplored.
Purpose of the Study:
- To evaluate a novel prehospital triage method (HART-c) for cardiac complaints.
- To compare the efficacy of this prehospital triage against usual ambulance care in reducing emergency department visits.
Main Methods:
- Patients with cardiac complaints assessed by emergency medical services (EMS) were included.
- A new platform facilitated cardiologist consultation using prehospital data, vital signs, ECG, and real-time hospital capacity.
- Shared decisions were made regarding hospital admission necessity and destination.
Main Results:
- The study assessed the feasibility and safety of the prehospital triage method.
- Adverse events for patients managed at home were monitored for 30 days via general practitioner contact.
Conclusions:
- The HART-c study investigates a prehospital triage system combining paramedic and cardiologist expertise.
- This method aims to decrease unnecessary emergency department visits for cardiac complaints.
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.
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