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Greene JA, Goldstein J, Stirling J, Swain JM, Brown R, McVey J, Carter A. Clinical Roles in the Medical Communications Centre: A Rapid Scoping Review. Cureus 2023; 15:e39441. [PMID: 37362545 PMCID: PMC10289204 DOI: 10.7759/cureus.39441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
In recent years, 911 call volumes have increased, and emergency medical services (EMS) are routinely stretched beyond capacity. To better match resources with patient needs, some EMS systems have integrated clinician roles into the emergency medical communications centre (MCC). Our objective was to explore the nature and scope of clinical roles in emergency MCCs. Using a rapid scoping review methodology, we searched PubMed for studies related to any clinical role employed within an emergency MCC. We accepted reviews, experimental and observational designs, as well as expert opinions. Studies reporting on dispatcher recognition and pre-arrival instructions were excluded. Title and abstract screening were conducted by a single reviewer, included studies were verified by two reviewers, and data extraction was completed in duplicate, all using Covidence review software. The level of evidence was assessed using the prehospital evidence-based practice (PEP) scale. The protocol was registered in Open Science Framework (10.17605/OSF.IO/NX4T8). Our search yielded 1071 titles, and four were added from other sources; 44 studies were reviewed at the full-text stage and 31 were included. The included studies were published from 2002 to 2022 and represent 17 countries. Studies meeting inclusion criteria consisted of level I (n=4, 11%), II (n=13, 37%), and III (N=6, 17%) methodologies, as well as 12 other studies (34%) with qualitative or other designs. Most of the included studies reported systems that employ nurses in the MCC (n=29, 83%). Twelve (34%) studies reported on the inclusion of paramedics in the MCC, and five (14%) reported physician involvement. The roles of these clinicians chiefly consisted of triage (n=25, 71%), advice (n=20, 57%), referral to non-emergency care (n=14, 40%), and peer-to-peer consulting (n=2, 4%). Alternative dispositions (as opposed to emergency ambulance transport) for low acuity callers included self-care, as well as referral to a general practitioner, pharmacist, or other outreach programs. There is a wide range of literature reporting on clinical roles integrated within MCCs. Our findings revealed that MCC nurses, physicians, and paramedics assist substantively with triage, advice, and referrals to better match resources to patient needs, with or without the requirement for ambulance dispatch.
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Affiliation(s)
| | | | | | - Janel M Swain
- Emergency Health Services, Nova Scotia, Dartmouth, CAN
| | - Ryan Brown
- Interprofessional Practice and Learning, Nova Scotia Health, Sydney, CAN
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | | | - Alix Carter
- Emergency Medicine, Dalhousie University, Halifax, CAN
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Jensen JL, Al-Dhalaan F, Rose J, Carter A, McVey J, Butts F, Hawco T, Rose P, Travers AH. Paramedic Clinical Consults with a Paramedic or Nurse in an EMS Communications Center Compared to Traditional Online Physician Consults. PREHOSP EMERG CARE 2022; 28:36-42. [PMID: 36441610 DOI: 10.1080/10903127.2022.2152512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD "peer to peer" consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures. METHODS This retrospective cohort study analyzed 2 months before (September 1 to October 31, 2012) and 2 months after (September 1 to October 31, 2013) implementation of the CSD. In the before period, all clinical consults were fielded by the direct medical oversight physician. In the after period, consults were fielded by the physician, CSD or both. EMS databases were queried, and manual chart review and abstraction of audio recordings were done. Relapses back to EMS within 48 hours of non-transport were measured. RESULTS 1621 consults were included, with 764 consults in the before period and 857 after (p = 0.02). The number of physician consults decreased from 764 before to 464 after (39.2%, p < 0.001), with the CSD taking 325 (37.9%) consults. The CSD was consulted more for police custody and trip destination. The physician was consulted more for cease resuscitation and clinical consults prior to medication administration. Overall non-transport rates were 595/764 before (77.9%), and 646/857 after (75.4%) (p = 0.2). Non-transports were 233/325 (71.7%) via the CSD, 364/464 (78.4%) via the physician, and 49/68 (72.1%) when both were involved (p = 0.07). Rate of relapse to EMS was similar before (25/524, 4.8%) and after (26/568, 4.6%) (p = 0.76), and between CSD (12/216, 5.5%) and physician consults (13/325, 4.0%) in the after period (p = 0.41). CONCLUSION The introduction of a novel "peer-to-peer" consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied.
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Affiliation(s)
- Jan L Jensen
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
- Medical Communications, Patient Flow and System Performance, Emergency Medical Care, Nova Scotia, Halifax, Canada
| | - Fahd Al-Dhalaan
- Department of Medicine, Dalhousie University Medical School, Halifax, Canada
| | - Jennifer Rose
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Medical Communications, Patient Flow and System Performance, Emergency Medical Care, Nova Scotia, Halifax, Canada
| | - Alix Carter
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Jennifer McVey
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
| | - Francine Butts
- Medical Communications, Patient Flow and System Performance, Emergency Medical Care, Nova Scotia, Halifax, Canada
| | - Terence Hawco
- Medical Communications, Patient Flow and System Performance, Emergency Medical Care, Nova Scotia, Halifax, Canada
| | - Peter Rose
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Medical Communications, Patient Flow and System Performance, Emergency Medical Care, Nova Scotia, Halifax, Canada
| | - Andrew H Travers
- Emergency Health Services, Department of Health and Wellness, Nova Scotia, Halifax, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Canada
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Ure A. Investigating the effectiveness of virtual treatment via telephone triage in a New Zealand general practice. J Prim Health Care 2022; 14:21-28. [DOI: 10.1071/hc21125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
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Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. METHODS This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). RESULTS 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21-3.30; OROFF 3.18, 95% CI 3.04-3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. CONCLUSIONS This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
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Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany.
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
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Lin CY, Lee YC. Effectiveness of hospital emergency department regionalization and categorization policy on appropriate patient emergency care use: a nationwide observational study in Taiwan. BMC Health Serv Res 2021; 21:21. [PMID: 33407444 PMCID: PMC7787133 DOI: 10.1186/s12913-020-06006-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use. METHODS Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from 1 million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation. RESULTS From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate. CONCLUSIONS Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.
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Affiliation(s)
- Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Taipei, Taiwan
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Master Program in Trans-disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Master Program in Trans-disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan.
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Spangler D, Hermansson T, Smekal D, Blomberg H. A validation of machine learning-based risk scores in the prehospital setting. PLoS One 2019; 14:e0226518. [PMID: 31834920 PMCID: PMC6910679 DOI: 10.1371/journal.pone.0226518] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to differentiate between low- and high-risk patients. This study validates a machine learning-based approach to generating risk scores based on hospital outcomes using routinely collected prehospital data. METHODS Dispatch, ambulance, and hospital data were collected in one Swedish region from 2016-2017. Dispatch center and ambulance records were used to develop gradient boosting models predicting hospital admission, critical care (defined as admission to an intensive care unit or in-hospital mortality), and two-day mortality. Composite risk scores were generated based on the models and compared to National Early Warning Scores (NEWS) and actual dispatched priorities in a prospectively gathered dataset from 2018. RESULTS A total of 38203 patients were included from 2016-2018. Concordance indexes (or areas under the receiver operating characteristics curve) for dispatched priorities ranged from 0.51-0.66, while those for NEWS ranged from 0.66-0.85. Concordance ranged from 0.70-0.79 for risk scores based only on dispatch data, and 0.79-0.89 for risk scores including ambulance data. Dispatch data-based risk scores consistently outperformed dispatched priorities in predicting hospital outcomes, while models including ambulance data also consistently outperformed NEWS. Model performance in the prospective test dataset was similar to that found using cross-validation, and calibration was comparable to that of NEWS. CONCLUSIONS Machine learning-based risk scores outperformed a widely-used rule-based triage algorithm and human prioritization decisions in predicting hospital outcomes. Performance was robust in a prospectively gathered dataset, and scores demonstrated adequate calibration. Future research should explore the robustness of these methods when applied to other settings, establish appropriate outcome measures for use in determining the need for prehospital care, and investigate the clinical impact of interventions based on these methods.
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Affiliation(s)
- Douglas Spangler
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Thomas Hermansson
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - David Smekal
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Blomberg
- Uppsala Center for Prehospital Research, Department of Surgical Sciences—Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
- Uppsala Ambulance Service, Uppsala University Hospital, Uppsala, Sweden
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Felzen M, Beckers SK, Kork F, Hirsch F, Bergrath S, Sommer A, Brokmann JC, Czaplik M, Rossaint R. Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study. J Med Internet Res 2019; 21:e14907. [PMID: 31596244 PMCID: PMC6806125 DOI: 10.2196/14907] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 01/20/2023] Open
Abstract
Background As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. Objective We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. Methods We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. Results The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. Conclusions The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.
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Affiliation(s)
- Marc Felzen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Kurt Beckers
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Felix Kork
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Frederik Hirsch
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Bergrath
- Emergency Department, Maria Hilf-Hospital Moenchengladbach, Moenchengladbach, Germany
| | - Anja Sommer
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Eastwood K, Morgans A, Stoelwinder J, Smith K. Patient and case characteristics associated with 'no paramedic treatment' for low-acuity cases referred for emergency ambulance dispatch following a secondary telephone triage: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2018; 26:8. [PMID: 29321074 PMCID: PMC5763642 DOI: 10.1186/s13049-018-0475-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage. METHODS A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012. Multivariable logistic regression modelling was used to identify explanatory variables associated with 'no paramedic treatment'. RESULTS There were 19,041 cases eligible for inclusion in this study over almost three years, of which 8510 (44.7%) were not treated after being sent an emergency ambulance following secondary triage. Age, time of day, pain, triage guideline group, and comorbidities were associated with 'no paramedic treatment'. In particular, cases 0-4 years of age or those with psychiatric conditions were significantly less likely to be treated by paramedics, and increasing pain resulted in higher rates of paramedic treatment. CONCLUSIONS This study highlights that case characteristics can be used to identify particular case types that may benefit from care pathways other than emergency ambulance dispatch. This process is also useful to identify gaps in the alternative care pathways currently available. These findings offer the opportunity to optimise secondary telephone triage services to support their strategic purpose of minimising unnecessary emergency ambulance demand and to match the right case with the right care pathway.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Ambulance Victoria, Victoria, Australia.
| | - Amee Morgans
- Emergency Services Telecommunications Authority, Victoria, Australia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Ambulance Victoria, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
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Eastwood K, Smith K, Morgans A, Stoelwinder J. Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study. BMJ Open 2017; 7:e016845. [PMID: 29038180 PMCID: PMC5652623 DOI: 10.1136/bmjopen-2017-016845] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. DESIGN A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. SETTING The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number. POPULATION Cases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways. MAIN OUTCOME MEASURES Appropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the 'average Victorian ED presentation'). RESULTS Planned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital. CONCLUSIONS Secondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways.
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Affiliation(s)
- Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Amee Morgans
- Emergency Services Telecommunications Authority, Melbourne, Victoria, Australia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Services Telecommunications Authority, Melbourne, Victoria, Australia
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Alrazeeni DM, Sheikh SA, Mobrad A, Al Ghamdi M, Abdulqader N, Al Gadgab M, Al Qahtani M, Al Khaldi B. Epidemiology of non-transported emergency medical services calls in Saudi Arabia. Saudi Med J 2017; 37:575-8. [PMID: 27146623 PMCID: PMC4880660 DOI: 10.15537/smj.2016.5.13872] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the epidemiology of non- transported emergency medical services (EMS) calls within the EMS system at Riyadh, Saudi Arabia, to identify factors that contributes to non-transport of patients by EMS provider, and to recommend suggestions for reduction in number of non-transported calls. METHODS Retrospective analysis of 1390 patient care reports (PCR) of non-transported cases responded to, and documented by the Saudi Red Crescent Authority (SRCA) emergency medical technicians (EMTs). All PCRs of non-transported cases from 10 EMS stations, in 3 consecutive months were examined. The SRCA EMTs management in Riyadh allocated all non-transported PCRs for 3 months (March-May 2014). Constructive data that includes patients demographics, scene characteristics, trip and timing information, length of stay, clinical and assessment data, and physician contact, or presence status were extracted from those PCRs. RESULTS Twenty-five percent of calls made during the study period were reported as non-transported calls. Seventy percent of non-transported calls were related to refusal by patient. Approximately 22.4% of non-transported calls were canceled by dispatch. Approximately 50% of non-transported patient were in the young age group (16-30 years). In 26% of non-transported calls, the field time was restricted to 15 minutes. CONCLUSION More than half of the non-transported emergency calls were reported as refused by patient/relative, while approximately one quarter were reported as cancelled calls.
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Affiliation(s)
- Daifallah M Alrazeeni
- Emergency Medical Services Department, Prince Sultan Bin Abdulaziz College of Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Goh GL, Huang P, Kong MCP, Chew SP, Ganapathy S. Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH. Singapore Med J 2017; 57:307-13. [PMID: 27353384 DOI: 10.11622/smedj.2016105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits. METHODS Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed. We collected data on patient demographics, attendance data and clinical characteristics. Planned reattendances, recalled cases, reattendances for unrelated complaints and patients who left without being seen were excluded. A multivariate analysis was conducted to determine the odds ratio of variables associated with hospital admission for reattendances. RESULTS Of 162,566 children, 6,968 (4.3%) returned within 72 hours, and 2,925 (42.0% of reattendance group) were admitted on their return visits. Children more likely to reattend were under three years of age, Chinese, triaged as Priority 2 at the first visit, and were initially diagnosed with respiratory or gastrointestinal conditions. However, children more likely to be admitted on their return visits were over 12 years of age, Malay, had a higher triage acuity or were uptriaged, had the presence of a comorbidity, and were diagnosed with gastrointestinal conditions. CONCLUSION We identified certain subgroups in the population who were more likely to be admitted if they reattended. These findings would help in implementing further research and directing strategies to reduce potentially avoidable reattendances and admissions.
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Affiliation(s)
- Guan Lin Goh
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Peiqi Huang
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | | | - So-Phia Chew
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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12
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Emergency medical triage decisions are swayed by computer-manipulated cues of physical dominance in caller's voice. Sci Rep 2016; 6:30219. [PMID: 27456205 PMCID: PMC4960535 DOI: 10.1038/srep30219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/30/2016] [Indexed: 01/11/2023] Open
Abstract
In humans as well as other animals, displays of body strength such as power postures or deep masculine voices are associated with prevalence in conflicts of interest and facilitated access to resources. We conduct here an ecological and highly critical test of this hypothesis in a domain that, on first thought, would appear to be shielded from such influences: access to emergency medical care. Using acoustic manipulations of vocal masculinity, we systematically varied the perceived level of physical dominance of mock patients calling a medical call center simulator. Callers whose voice were perceived as indicative of physical dominance (i.e. those with low fundamental and formant frequency voices) obtained a higher grade of response, a higher evaluation of medical emergency and longer attention from physicians than callers with strictly identical medical needs whose voice signaled lower physical dominance. Strikingly, while the effect was important for physician participants, it was virtually non-existent when calls were processed by non-medically-trained phone operators. This finding demonstrates an unprecedented degree of vulnerability of telephone-based medical decisions to extra-medical factors carried by vocal cues, and shows that it may not simply be assumed that more medical training will shield decisions from such influences.
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New models of emergency prehospital care that avoid unnecessary conveyance to emergency department: translation of research evidence into practice? ScientificWorldJournal 2013; 2013:182102. [PMID: 23818815 PMCID: PMC3684122 DOI: 10.1155/2013/182102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/15/2013] [Indexed: 11/24/2022] Open
Abstract
Background. Achieving knowledge translation in healthcare is growing in importance but methods to capture impact of research are not well developed. We present an attempt to capture impact of a programme of research in prehospital emergency care, aiming to inform the development of EMS models of care that avoid, when appropriate, conveyance of patients to hospital for immediate care. Methods. We describe the programme and its dissemination, present examples of its influence on policy and practice, internationally, and analyse routine UK statistics to determine whether conveyance practice has changed. Results. The programme comprises eight research studies, to a value of >£4 m. Findings have been disseminated through 18 published papers, cited 274 times in academic journals. We describe examples of how evidence has been put into practice, including new models of care in Canada and Australia. Routine statistics in England show that, alongside rising demand, conveyance rates have fallen from 90% to 58% over a 12-year period, 2,721 million fewer journeys, with publication of key studies 2003–2008. Comment. We have set out the rationale, key features, and impact on practice of a programme of publicly funded research. We describe evidence of knowledge translation, whilst recognising limitations in methods for capturing impact.
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Huibers L, Smits M, Renaud V, Giesen P, Wensing M. Safety of telephone triage in out-of-hours care: a systematic review. Scand J Prim Health Care 2011; 29:198-209. [PMID: 22126218 PMCID: PMC3308461 DOI: 10.3109/02813432.2011.629150] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Telephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care. METHODS A systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours medical care and focused on telephone triage in patients with a first request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem). RESULTS Thirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5-97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7-90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7-49.8%) were safe. Adverse events described in the studies included mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n=1), and medical errors (n = 6). CONCLUSIONS There is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice.
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Affiliation(s)
- Linda Huibers
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
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15
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Hansen EH, Hunskaar S. Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios. BMJ Qual Saf 2011; 20:390-6. [PMID: 21262792 PMCID: PMC3088408 DOI: 10.1136/bmjqs.2010.040824] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n=18, response rate 90%) as a test–retest assessment. Results Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage.
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Snooks H, Cheung WY, Close J, Dale J, Gaze S, Humphreys I, Lyons R, Mason S, Merali Y, Peconi J, Phillips C, Phillips J, Roberts S, Russell I, Sánchez A, Wani M, Wells B, Whitfield R. Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial. BMC Emerg Med 2010; 10:2. [PMID: 20102616 PMCID: PMC2824628 DOI: 10.1186/1471-227x-10-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 01/26/2010] [Indexed: 11/21/2022] Open
Abstract
Background Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen. Trial Registration ISRCTN10538608
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Affiliation(s)
- Helen Snooks
- Centre for Health Information Research and Evaluation, Swansea University, Swansea UK.
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Derkx HP, Rethans JJE, Muijtjens AM, Maiburg BH, Winkens R, van Rooij HG, Knottnerus JA. Quality of clinical aspects of call handling at Dutch out of hours centres: cross sectional national study. BMJ 2008; 337:a1264. [PMID: 18790814 PMCID: PMC2769520 DOI: 10.1136/bmj.a1264] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2008] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the quality of telephone triage by following the consecutive phases of its care process and the quality of the clinical questions asked about the patient's clinical condition, of the triage outcome, of the content of the home management advice, and of the safety net advice given at out of hours centres. DESIGN Cross sectional national study using telephone incognito standardised patients. SETTING The Netherlands. PARTICIPANTS 17 out of hours centres. MAIN OUTCOME MEASURES Percentages of clinical obligatory questions asked and items within home management and safety net advice, both in relation to pre-agreed standards, and of care advice given in relation to the required care advice. RESULTS The telephone incognito standardised patients presented seven clinical cases three times each over a period of 12 months, making a total of 357 calls. The mean percentage of obligatory questions asked compared with the standard was 21%. Answers to questions about the clinical condition were not always correctly evaluated from a clinical viewpoint, either by triagists or by general practitioners. The quality of information on home management and safety net advice varied, but it was consistently poor for all cases and for all out of hours centres. Triagists achieved the appropriate triage outcome in 58% of calls. CONCLUSION In determining the outcome of the care process, triagists often reached a conclusion after asking a minimal number of questions. By analysing the quality of different phases within the process of telephone triage, evaluation of whether an appropriate triage outcome has been arrived at by means of good clinical reasoning or by an educated guess is possible. In terms of enhancing the overall clinical safety of telephone triage, apart from obtaining an appropriate clinical history, adequate home management and safety net advice must also be given.
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Affiliation(s)
- Hay P Derkx
- Department of General Practice, Maastricht University, Maastricht, Netherlands.
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18
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Moll van Charante EP, van Steenwijk-Opdam PCE, Bindels PJE. Out-of-hours demand for GP care and emergency services: patients' choices and referrals by general practitioners and ambulance services. BMC FAMILY PRACTICE 2007; 8:46. [PMID: 17672915 PMCID: PMC2082275 DOI: 10.1186/1471-2296-8-46] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 08/01/2007] [Indexed: 11/29/2022]
Abstract
Background Over the last five years, Dutch provision of out-of-hours primary health care has shifted from practice-based services towards large-scale general practitioner (GP) cooperatives. Only few population-based studies have been performed to assess the out-of-hours demand for GP and emergency care, including the referral patterns to the Accident and Emergency Department (AED) by GPs and ambulance services. Method During two four-month periods (five-year interval), a prospective cross-sectional study was performed for a Dutch population of 62,000 people. Data were collected on all patient contacts with one GP cooperative and three AEDs bordering the region. Results Overall, GPs handled 88% of all out-of-hours contacts (275/1000 inhabitants/year), while the AED dealt with the remaining 12% of contacts (38/1000 inhabitants/year). Within the AED, the self-referrals represented a substantial number of contacts (43%), although within the total out-of-hours demand they only represented 5% of all contacts. Self-referrals were predominantly young adult males presenting with an injury, nineteen percent of whom had a fracture. Compared to self-referrals, patients who were referred by the GP or brought in by the ambulance services were generally older and were more frequently admitted for both injury and non-injury (p < 0.01 for all differences). Conclusion The GP cooperative deals with the large majority of out-of-hours problems presented. Within the total demand, self-referrals constitute a stable, yet small group of patients, many of whom seem to have made a reasonable choice to attend the AED. The GPs and the ambulance services appear to be effectively selecting the problems that are presented to the AED.
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Affiliation(s)
- Eric P Moll van Charante
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | | | - Patrick JE Bindels
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
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Giesen P, Ferwerda R, Tijssen R, Mokkink H, Drijver R, van den Bosch W, Grol R. Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency? Qual Saf Health Care 2007; 16:181-4. [PMID: 17545343 PMCID: PMC2465002 DOI: 10.1136/qshc.2006.018846] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed. OBJECTIVES To investigate whether triage nurses accurately estimate the urgency level of health complaints when using the national telephone guidelines, and to examine the relationship between the performance of triage nurses and their education and training. METHOD A cross-sectional, multicentre, observational study employing five mystery (simulated) patients who telephoned triage nurses in four GP cooperatives. The mystery patients played standardised roles. Each role had one of four urgency levels as determined by experts. The triage nurses called were asked to estimate the level of urgency after the contact. This level of urgency was compared with a gold standard. RESULTS Triage nurses estimated the level of urgency of 69% of the 352 contacts correctly and underestimated the level of urgency of 19% of the contacts. The sensitivity and specificity of the urgency estimates provided by the triage nurses were found to be 0.76 and 0.95, respectively. The positive and negative predictive values of the urgency estimates were 0.83 and 0.93, respectively. A significant correlation was found between correct estimation of urgency and specific training on the use of the guidelines. The educational background (primary or secondary care) of the nurses had no significant relationship with the rate of underestimation. CONCLUSION Telephone triage by triage nurses is efficient but possibly not safe, with potentially severe consequences for the patient. An educational programme for triage nurses is recommended. Also, a direct second safety check of all cases by a specially trained GP telephone doctor is advisable.
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Affiliation(s)
- Paul Giesen
- Centre for Quality of Care Research, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Shaw D, Dyas JV, Middlemass J, Spaight A, Briggs M, Christopher S, Siriwardena AN. Are they really refusing to travel? A qualitative study of prehospital records. BMC Emerg Med 2006; 6:8. [PMID: 16984647 PMCID: PMC1592119 DOI: 10.1186/1471-227x-6-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 09/19/2006] [Indexed: 11/17/2022] Open
Abstract
Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT) in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397) who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.
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Affiliation(s)
- Deborah Shaw
- East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK
| | - Jane V Dyas
- Trent Research and Development Support Unit, Division of Primary Care, 13th Floor, Tower Building, University of Nottingham, UK
| | - Jo Middlemass
- Nottingham Primary Care Research Partnership, Hucknall Health Centre, Curtis Street, Hucknall, Nottingham, UK
| | - Anne Spaight
- East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK
| | - Maureen Briggs
- East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK
| | - Sarah Christopher
- East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK
| | - A Niroshan Siriwardena
- East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK
- University of Lincoln, School of Health and Social Care, University of Lincoln Court 11, Apartment 1, Room 2, Campus Way, Lincoln LN6 7BG, UK
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Patterson PD, Baxley EG, Probst JC, Hussey JR, Moore CG. Medically unnecessary emergency medical services (EMS) transports among children ages 0 to 17 years. Matern Child Health J 2006; 10:527-36. [PMID: 16816999 DOI: 10.1007/s10995-006-0127-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 06/08/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Estimate the prevalence of medically unnecessary Emergency Medical Services (EMS) transports among children. METHODS We linked EMS and emergency department (ED) billing records for all EMS-to-hospital transports of children originating in three counties in South Carolina between January 1, 2001 and March 31, 2003. EMS responses resulting in no transport, transports to destinations other than the ED, or multiple trips for the same child in a single day could not be linked to ED data and were excluded. Medically unnecessary transports were identified with an algorithm using pre-hospital impressions, ED diagnoses and ED procedures. After exclusions, 5,693 transports of children between 0 and 17 years were available for study. RESULTS Sixteen percent (16.4%) of all transports were medically unnecessary. Among children through age 12, upper respiratory and viral problems were the most common diagnoses associated with medically unnecessary transports; among older children, behavioral problems such as conduct disturbance or drug abuse were common. In multivariable analysis, the odds of an unnecessary transport were higher among younger children, non-white children, rural children, and children insured by Medicaid. CONCLUSIONS The proportion of EMS transports which may be medically unnecessary is relatively modest compared to previous studies. However, many questions remain for future research. Further investigation should include examination of primary care availability and occurrence of unnecessary EMS use, existence of race-based disparities, and transports involving conduct disturbance and other behavioral conditions among children.
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Affiliation(s)
- P Daniel Patterson
- Cecil G Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr., Blvd., CB# 7590, Chapel Hill, NC 27599, USA.
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