DEVELOPMENT AND EVALUATION OF THE “EMERGENCY MEDICAL ALLIANCE FOR TOTAL COODINATION IN HEALTHCARE (E-MATCH)” TO PROMOTE SHARED DECISION MAKING BETWEEN EMTS AND MEDICAL FACILITIES

Background:When emergency medical technicians (EMTs) in Japan make the initial call to hospitals to accept patients, they often have trouble identifying appropriate medical facilities that can accommodate the various patient conditions. Mismatches of this sort can be problematic and are a growing social problem, as they often result in emergency patients being transferred but then rejected at several hospitals.  

Purpose: To design, develop, and evaluate the “emergency Medical Alliance for Total Coordination in Healthcare (e-MATCH)”, a decision support tool that resolves discrepancies between patient needs and available resources, and promotes shared decision-making between EMTs and medical facilities.

Methods: We developed a rule-based algorithm that integrates on-site EMT observations, vital signs, and resource availability and current status of each facility. These data help to classify patient severity and recommend hospitals capable of providing appropriate care. All formal information can be shared among EMTs who select where to transport patients and physicians who decide whether or not to accept patients. We implemented the algorithm in e-MATCH, which runs on an iPad2 platform. e-MATCH began operation on April 1, 2012. Consecutive patients transferred from January 31, 2011 to January 31, 2012 (before operation) and from April 1 to 30, 2012 (after operation) were analyzed to compare the proportion of patients accepted after >4 calls (>4 %) and average time from the first call to the EMT’s decision regarding hospital to transport patients.

Results: Before and after e-MATCH operation, there were 30,414 and 1,983 patients, of whom 12.7% (3,865/30,414) and 9.2% (183/1,983) were >4% (p<0.0001), respectively. Average times required to determine where patients should be transported were 13.2 min and 8.4 min (p<0.0001) before and after e-MATCH operation, respectively.

Conclusion: The e-MATCH reduced the number of calls and the time required for decisions on patient transport. Our results demonstrate e-MATCH potential to transport the right patients to the right place at the right time.