Clinical Trial Details
— Status: Recruiting
Administrative data
| NCT number |
NCT05773508 |
| Other study ID # |
2022-120 |
| Secondary ID |
|
| Status |
Recruiting |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
March 6, 2023 |
| Est. completion date |
June 6, 2025 |
Study information
| Verified date |
March 2023 |
| Source |
University Hospital, Angers |
| Contact |
Delphine Douillet, MD,PhD |
| Phone |
+33241353637 |
| Email |
Delphine.Douillet[@]chu-angers.fr |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
The aim is to evaluate the effectiveness of the device (emergency kit and video-medical
control in emergency call centers) in reducing deep night hospitalizations of elderly people
living in retirement homes.
Description:
Approximately 500,000 elderly people live in a nursing homes in France (1). Few studies
concern these subjects: 2% of international research studies (1). Among the subjects
hospitalised in the emergency department, those from a nursing home represent a significant
proportion of the population, with a proportion of 9 to 37% (2). These are mainly elderly
patients who are dependent in the acts of daily life, polypathological and with multiple
medications (1,2) and for whom any aggression can lead to hospitalisation, a source of
physical and psychological destabilisation (3).
Unplanned hospitalisations are frequent: one resident in ten has been hospitalised in the
last three months, and up to five in ten over a full year. Ninety-five percent of the reasons
for hospitalisation include cardiac decompensation, the consequences of falls, respiratory
disorders, confusion, febrile or non-febrile infections, particularly dermatological,
dehydration and gastrointestinal disorders, particularly diarrhoea (4).
These hospitalisations are considered to be avoidable in 7 to 67% of cases, depending on the
authors (2). This seems to be explained in particular by the lack of availability of doctors
or paramedics to identify or carry out the appropriate technical care or simple complementary
examinations (5). During the night, the only staff present in these facilities are often
orderlies who are less experienced in assessing emergencies. In a recent study, however, they
were the ones who influenced the alert and decided to hospitalise in 40% of cases (6).
The value of specific channels for nursing home patients in reducing avoidable
hospitalisations has been highlighted, by favouring short non-emergency channels,
particularly for complementary examinations and technical care (7).
The possibility of having a rapid medical assessment on-site, a biological analysis within
three hours or the implementation of intravenous hydration would avoid the systematic passage
of patients residing in nursing homes through the emergency department. The value of advance
directives notifying the non-resuscitation situations desired by the patient would make it
possible to further reduce this figure (4).
Inappropriate hospitalisations must therefore be avoided by improving decision-making
procedures (8).
The use of video regulation has become more widespread since the SARS-CoV-2 pandemic,
allowing continuity of care while minimising the risk of virus transmission. Numerous
advantages have emerged from this rapidly developing technology, in particular the
possibility of remotely monitoring the progress of the most stable patients, while limiting
their movements, and keeping the possibility of calling them in person if necessary. (9)
However, the technology of video consultation requires an upgrade in the use of the computer
tool by both patients and nursing staff (nurses, doctors). Telephone consultations may be
preferred for ease of use, especially for elderly patients, as they will offer less
information and more uncertain diagnoses than video consultation (10,11).
A pilot study has shown that video regulation in Emergency Dispatch Center (SAMU C15 in
France) is a tool that improves the decision of the regulating doctor in almost 50% of cases,
particularly in the case of traumatology (12).
In Maine-et-Loire, emergency kits have been in place since the end of 2022, allowing the
prescription of emergency drugs by non-medical staff via video-regulation with the emergency
doctor. The aim is to be able to deliver treatments during the night, so that the nursing
home doctor can assess the patient's condition in the morning. The emergency kit was
developed in collaboration with the EHPAD coordinating doctors, the Emergency Dispatch Center
of Angers and the geriatric doctors of the University Hospital of Angers.
The objective of this research is to evaluate this new device. It will compare the rate of
night hospitalisation of patients residing in nursing home according to the use or not of
visio-regulation coupled with the emergency kit by the Emergency physician working in the
Emergency Dispatch Center. At the start of the study, not all the nursing home in the
department will be equipped with an emergency kit. We will therefore compare the calls to the
Emergency Dispatch Center of the nursing homes with the emergency kit and the use of
visio-regulation with the calls from nursing homes that do not yet have this device.
