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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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Sakurai A, Ohta S, Oda J, Muguruma T, Abe T, Morimura N. ABCD approach at the #7119 center, telephone triage system in Tokyo, Japan; a retrospective cohort study. BMC Emerg Med 2022; 22:66. [PMID: 35439949 PMCID: PMC9020061 DOI: 10.1186/s12873-022-00625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The algorithm and protocol of the #7119 telephone triage in Tokyo, Japan, had been originally established and consists of three steps. In this study, we investigated the outcome of patients treated with physiological abnormality (ABCD approach: A, airway; B, breathing; C, circulation, and D, dysfunction of central nervous system) in step 2 during the #7119 telephone triage and clarified the meaning of evaluation of this approach. Methods We retrospectively reviewed data from the Tokyo Fire Department from January 2016 to December 2017. Almost all the patients triaged using the ABCD approach were transferred to the hospital by ambulance and assigned severity by a physician. We divided patients into groups with combinations of 15 patterns including A, B, C, D, AB, AC, AD, BC, BD, CD, ABC, ABD, ACD, BCD, and ABCD. We compared the proportion of severe cases in each group using a Fisher's exact test, followed by residual analysis. Results We analyzed 13,793 cases triaged using the ABCD approach. In this analysis, 31% of total cases were assessed as severe cases. Groupwise analysis showed that the proportion of severe cases was significantly higher in the AD, BC, CD, ABD, and ABCD groups, while it was significantly less in the C and AB groups than in the total cases. Conclusion At the #7119 telephone triage, we can pick up the severe cases by the ABCD approach. This may contribute to the prompt transportation of severe patients to hospitals by dispatching ambulance cars using the #7119 telephone triage methods.
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Affiliation(s)
- Atsushi Sakurai
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan. .,Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Oyaguchikamichou 30-1, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sachiko Ohta
- Department of Pharmaceutical and Medical Business Sciences, Nihon Pharmaceutical University, 3-15-9 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.,Research and Analysis, Center for Health Service Outcome Research and Development, 23-17-408 Sakuragaokashou, Shibuya-ku, Tokyo, 150-0031, Japan
| | - Jun Oda
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takashi Muguruma
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 3-9 Kanazawa-ku Fukuura, Yokoyama-city, Kanagawa, 236-0004, Japan
| | - Takeru Abe
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Minami-ku Urafunemachi, Yokoyama city, Kanagawa, 232-0024, Japan
| | - Naoto Morimura
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emeregency Medicine, Teikyo Univeristy School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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Kakimoto K, Shibahashi K, Oishio M, Sugiyama K, Hamabe Y. Mortality of hospital
walk‐in
trauma patients: a multicenter retrospective cohort study. Acute Med Surg 2022; 9:e784. [PMID: 36092465 PMCID: PMC9448715 DOI: 10.1002/ams2.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/17/2022] [Indexed: 01/09/2023] Open
Abstract
Aim To investigate the characteristics of patients who visited the emergency department by themselves after experiencing trauma and subsequently died, and to identify the prognostic factors of mortality in such patients. Methods Adult patients with trauma visiting the emergency department by themselves between 2004 and 2019 in Japan were identified using a nationwide trauma registry (the Japan Trauma Data Bank). The characteristics of patients who died were compared with those who survived, and multivariable logistic regression analysis was used to determine the independent association of each preselected variable with in‐hospital mortality (end‐point). Results Of the 9753 patients eligible for analysis, 4369 (44.8%) were men, and the median age was 75 years. Of these patients, 130 (1.3%) died in the hospital. The following factors had a significant association with in‐hospital mortality: age, male sex, Charlson Comorbidity Index (CCI) 3–4 and ≥5 with CCI = 0 as a reference, circumstances of injury (free fall and fall at ground level), Glasgow Coma Scale score, Shock Index ≥ 0.9, severe injuries of the head, abdomen and lower extremities, and Injury Severity Score ≥ 15. Conclusions Several risk factors, including older age, male sex, higher CCI, circumstances of injury (free fall and fall at ground level), lower Glasgow Coma Scale score, higher Shock Index, and severe injuries of the head, abdomen, and lower extremities, were identified as being associated with the death of trauma patients visiting the emergency department by themselves. Early identification of patients with these risk factors and appropriate treatment may reduce mortality posttrauma.
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Affiliation(s)
- Kohei Kakimoto
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Keita Shibahashi
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Masato Oishio
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center (Trauma and Critical Care) Tokyo Metropolitan Bokutoh Hospital Tokyo Japan
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Inokuchi R, Jin X, Iwagami M, Abe T, Ishikawa M, Tamiya N. Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study. BMC Emerg Med 2021; 21:155. [PMID: 34911465 PMCID: PMC8672574 DOI: 10.1186/s12873-021-00552-x] [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: 06/19/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prehospital telephone triage stratifies patients into five categories, "need immediate hospital visit by ambulance," "need to visit a hospital within 1 hour," "need to visit a hospital within 6 hours," "need to visit a hospital within 24 hours," and "do not need a hospital visit" in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. METHODS We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. RESULTS We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16-64, 65-74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71-3.36], 8.57 [95% CI 4.83-15.2], and 14.9 [95% CI 9.65-23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25-4.26]); those with dementia (2.32 [95% CI 1.05-5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01-3.87]) as more likely to be undertriaged. CONCLUSIONS We found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.
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Affiliation(s)
- Ryota Inokuchi
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toshikazu Abe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masatoshi Ishikawa
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
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